Foreign Affairs Committee on April 25th, 2022

[Kiersten Combs]

I would recommend to anybody that yes, you follow the public health guidance that is given in your local area. We have the benefit here that we have other vaccines available to us. Absolutely, I would suggest that following public health guidance is the way to go.

I also know that not everywhere in the world is in the same situation. On the risk-benefit profile, there are global regulatory bodies that suggest that the risk-benefit profile for Vaxzevria is a beneficial one. It is beneficial to the individual, so taking the vaccine is recommended in certain parts of the world.

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

Okay.

Just to follow up on that, the recommendation from Canada's health authorities at the provincial and national level is that those who are under 55 not take it.

Do you have any evidence to suggest, for instance, that the risk of vaccine-induced thrombocytopenia is lower in certain developing countries than it is in Canada? We're talking about the same disease here.

[Kiersten Combs]

No, I have no scientific evidence to prove that, but I also very much respect and defer to the public health authorities in the local areas, where the population should follow their guidance on which vaccines they choose to receive and administer in those areas. That's all I'm saying.

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

Okay.

I think it is a bit of a problem when we have one set of health advice in one country and a different set of health advice in another country. You're saying to follow the health advice wherever you are, even though we're talking about the same compounds.

Can I ask one more question on your vaccine specifically? Was your company aware of the side effect risk profile prior to the statement being released a year ago from the National Advisory Committee on Immunization?

[Kiersten Combs]

When side effects started to be identified in the general population, our organization....

Remember that this product is a little bit different from a lot of vaccines and, I would suggest, from any type of pharmaceutical product, in that it was distributed and administered to a wide, diverse population almost across the globe in a very short amount of time. It was a much shorter amount of time than usual for a medicine to be introduced into the general population—

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

I'm sorry, ma'am. I have very limited time. I'd like to give you all the time I can, but in 10 more seconds I have to ask Mr. Paquette.

Were you aware of these risks prior to that statement being released?

[Kiersten Combs]

AstraZeneca was aware of the risks associated with Vaxzevria at the time when we made it publicly known.

As we follow, in any type of—

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

I'm sorry. I have to proceed to Mr. Paquette. You can certainly follow up with the committee in writing.

Mr. Paquette, you spoke about vaccine hesitancy. In 2009, your company paid $2.3 billion U.S. in what was then the largest health care fraud settlement in U.S. history. This was related to allegations that you illegally promoted four drugs—Bextra, Geodon, Zyvox and Lyrica.

I share the concerns about vaccine hesitancy. Do you think settlements like this have contributed to a lack of trust in the pharmaceutical industry and vaccine hesitancy around the world?

[Fabien Paquette]

Thank you for your question.

Actually, vaccine hesitancy has been in place for a long time, for as long as vaccines have been out there. It's not new; it's something that has been seen.

We see different types of vaccine hesitancy. We see people who are pure anti-vaxxers and who really will never get a vaccine, while other people are just looking at getting a little bit more insight, understanding and information about vaccines.

I think what is critical here is to provide education, with health care providers giving the right information to the audience.

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

Sir, I guess—

[The Chair, Liberal, Sven Spengemann]

Thank you very much, Mr. Genuis. That's actually over six minutes.

Dr. Fry, you have six minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I want to thank you for coming and providing us with.... You're going to get a hard time from this committee, as you well know.

As a physician, I can say that it's well known that different individuals and groups react to different drugs in different ways. One cannot look at a broad consensus and say that because something happened to group A, it's necessarily going to happen to group B. That's the whole thing about the risk-benefit profile that tends to happen.

I want to ask you a question. You talked a lot about vaccine hesitancy. I want to know what you think causes vaccine hesitancy, other than fear that it's going to hurt you. You talked about the readiness of countries to be able to give the vaccine—not to produce it, but to be able to give it and get it into populations. You also talked about the WTO and supply chain problems.

First, I want to know what you think is a cause and what can you do about vaccine hesitancy. Education is indeed one thing. Also, what are you going to do about the fact that now that you have a lot of vaccines and production is paused, some countries aren't even ready to give it? What do you think can be done to assist in getting the infrastructure necessary and in getting the people who are able to give these vaccines? I mean, it doesn't have to be a physician or a nurse. It could be somebody who is trained to deliver a vaccine. What are you going to do to make that happen?

Second, what are you going to do about the supply chain problems at WTO? How are you working with WTO? What is the challenge? Why is there blockage at WTO, other than some countries not wanting to make some agreements that are necessary to get this to move forward?

[Fabien Paquette]

Dr. Fry, is the question for me?

[Hedy Fry, Liberal, Vancouver Centre, BC]

It's for both of you, actually, but you can start, Mr. Paquette.

[Fabien Paquette]

First of all, vaccine hesitancy needs to be taken seriously. It differs from one country to another. The rationale as to why people may refuse vaccination or have concerns about getting vaccinated is based on different elements that need to be further understood, described and explained. I think education remains the fundamental way to help people slowly get more on board with immunization.

There is so much evidence. Science is so clear about the value of immunization and vaccines. It's a question of making sure we take the time to listen and understand the concerns being raised, provide as much support as possible and give people the time to actually reflect on this and see the value.

We've seen an increased number of people getting vaccinated as we see the pandemic going on. We see people getting vaccines on a regular basis, and that has helped to convince others of the safety and the efficacy of the vaccine. Those are basically the fundamentals we need to address.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Can you talk about what the challenges are with regard to supply chain problems? I know trade is one, and the WTO. Is the WTO addressing this, or is it stymied by some countries not wanting to do anything about it?

[Fabien Paquette]

It's really interesting, because right now, as we have significant capacity and access to vaccines, the real challenge is really the deployment of these vaccines in different countries.

If we take the example of our mRNA technology, there is a challenge related to the cold chain process. We need to make sure that the delivery of the vaccine respects the very strict guidance that applies to the cold chain. We've realized that some countries might not have the capabilities right now, or did not have them in the past, to actually be able to fully deliver our vaccines as quickly as they would like to. This is a limitation that we need to be aware of.

Our role is to help these countries get the equipment required—for instance, ultra-low temperature freezers to make sure they can store the vaccines safely—and also help them to optimally deploy the vaccines to their population. We always know that the last mile is very important. We need to make sure that we can provide the vaccines to where the people are. That process is quite complex. We probably need to have more investments in infrastructure in these countries.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

Ms. Combs, do you have anything to add? I know Mr. Genuis asked you a lot about AstraZeneca and the thrombocytopenia issue. As I said before, one can argue, as you say, the risk-benefit aspect. Basically, I think you've said the benefit outweighed the risk, but are you having problems other than people being afraid to take this particular vaccine in some countries? Do you see any other ways?

For instance, I wanted to hear some of you talk about the ability to train people to deliver vaccines, to put the needle in the arm. You don't have to be a physician or nurse to do that. Many people can be trained to do that.

How do you see this moving forward? As variants change regularly, some of us are going to find that these vaccines aren't going to work. What is your answer to that?

[The Chair, Liberal, Sven Spengemann]

Give just a brief answer, please, in the interest of time.

[Kiersten Combs]

Quickly, as my colleague just mentioned, the different vaccines have different supply chains. We have all learned how to distribute them at the local level.

I think your idea of being able to train folks to deliver them is actually a very good one. As we all become even much more sophisticated in the business model, we will explore that as an ecosystem.

You can also see that 2.6 billion doses from AstraZeneca have been distributed in lower- to mid-tier countries. It does show the difference between the supply chain and being able to get different types of medicines into local areas to actually administer them.

[The Chair, Liberal, Sven Spengemann]

Thank you very much. Thank you, Dr. Fry.

Mr. Bergeron, you have six minutes. Go ahead.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

In mid‑March, we learned through media leaks of a compromise agreement between South Africa, the U.S., India and the E.U. on a possible waiver on COVID‑19 vaccine patents and a possible World Trade Organization agreement on trade‑related aspects of intellectual property rights, known as TRIPS.

First, can you tell us whether you were involved in those discussions? I imagine you were. Can you tell us where those discussions are at?

[Fabien Paquette]

Ms. Combs, do you want to start?

[Kiersten Combs]

Go ahead, Fabien.

[Fabien Paquette]

I'll answer you in French, Mr. Bergeron, since you asked the question in French.