Foreign Affairs Committee on April 25th, 2022

[Ali Ehsassi, Liberal, Willowdale, ON]

I'm sorry. I thought I didn't.

Again, I just want to return to this point. Perhaps if we can hear from Ms. Caprani. How do we ensure that the workforce is there and that as members of the international community, we are doing our part to build that capacity? This seems to be the critical question.

[The Chair, Liberal, Sven Spengemann]

Could we have just a brief answer, please?

[Lily Caprani]

I would agree. It's one of the most critical components to expanding capacity. We do need a significantly larger primary health care workforce, not just in order to tackle the pandemic but in order to catch up on the lost gains in routine immunization and to rebuild those highly disrupted health care systems. It will take both domestic investment of resources and better coordination and alignment by international donors as well.

In terms of the role of a government like Canada's, I think it's both: by investing in those delivery challenges and by leading by example and using your influence in fora like the G7, the G20 and the UN General Assembly to convey the message to other donor partners that coordination and a very clear focus on investing sustainably in the primary health care workforce is going to be one of the most important tools, not just in ending this pandemic but in preparing for the next one as well.

[The Chair, Liberal, Sven Spengemann]

Thank you, Mr. Ehsassi, and to the witnesses.

We now go to Mr. Bergeron for six minutes.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

I'd like to thank the witnesses for being with us today and for enlightening us with their comments.

On March 21, Joshua Tabah, director general of the health and nutrition section of the Department of Foreign Affairs, Trade and Development, suggested that there was a supply issue with vaccines in 2021, whereas now it's more of a demand issue. That's what you're confirming or seem to be confirming today. We're having trouble getting available vaccines into arms, from what I understand.

Furthermore, Mr. Ehsassi talked about the lack of qualified personnel. We could also talk about other factors, such as the cold chain and large distances to travel to cover small isolated villages here and there, but also the vaccine hesitancy found in some countries.

The World Health Organization announced last Thursday that 1 million African children have been vaccinated against malaria. We've been told that an average of 6 million people are currently being vaccinated in Africa each week against COVID‑19 and that this number would need to increase to 36 million to reach the target of 70% vaccination coverage.

My question to both witnesses is this: In Africa, is there the same kind of hesitancy toward the malaria vaccine as there is toward COVID‑19 vaccines?

[Dr. Seth Berkley]

The malaria situation is quite different. Malaria was only recently recommended as a vaccine by the WHO steering committee. Prior to this, we were doing a pilot study to see how the vaccine could be implemented in the community. Would people continue to use bed nets, given that the vaccine is not 100% efficacious? With an understanding that people would continue to use bed nets and could get good coverage, it's recently been recommended, but it has not been rolled out more generally.

The challenge for the malaria vaccine—there's been enormous demand—has been that, at the moment, there is not a large amount of supply. There have been difficulties in manufacturing it. We are working to try to see if the vaccine can be scaled up in larger quantities, as well as having other manufacturers come in with other vaccines.

On your broader question of hesitancy, the hesitancy for COVID has been worse than with other vaccines, partially because it's been politicized in the west. They share the same mass communication platforms and social media that we have in the west. What we are seeing are rumours and misinformation spreading and causing hesitancy.

Of course, the partners on the ground are always working to try to make sure that people have the right information. Local political leaders and health care workers are working to try to provide that information to overcome that hesitancy, but it is a bigger challenge with COVID-19 than we've seen with any other vaccine to date.

[Stéphane Bergeron, Bloc, Montarville, QC]

Does that include the malaria vaccine?

[Dr. Seth Berkley]

There has not yet been a campaign to roll out the vaccine for malaria. There is a current effort looking at how the vaccine will be rolled out, given the fact that there isn't an adequate supply for everybody who will want it. There will be an allocation mechanism that looks at places that have the highest incidence of malaria combined with inaccessibility and therefore the most usefulness until there's more availability. We also had to do that with the COVID-19 vaccines at the beginning, when there were not enough doses available.

I suspect Lily might have some things she would want to say on this as well. I don't know if you'd like to give her a voice.

[Stéphane Bergeron, Bloc, Montarville, QC]

Yes, of course.

[Lily Caprani]

Thank you.

On the issue of vaccine demand—and I'm deliberately using the word “demand” and not “hesitancy”—I think it's very important that we don't fall into the trap of assuming that lower-than-ideal demand and uptake are entirely about hesitancy around the product or the science of the vaccines. The evidence doesn't support that. In fact, multiple institutional surveys across countries in Africa have found that the vast majority of people, when asked whether they intend to get vaccinated, say that yes, they do. When we ask them why they are not yet vaccinated, the reasons are more complex than simple hesitancy. Often it's a matter of convenience or of understanding or of having the right information, as opposed to some sort of principled objection to vaccination. While hesitancy is real, it's often overstated as one of the problems with demand.

A couple of things can be done to improve that situation. One is, as we've mentioned, the kind of risk communication and engagement with communities that allows them to access reliable information, often via a community-embedded health care worker. This will go a great deal of the way towards addressing it. Second, making access to these vaccines convenient by bundling and integrating them with other health systems will also make a huge difference to uptake and demand.

That's not to say misinformation isn't a challenge; it is, but it's important that we not put all of the blame on that. It's a misunderstanding of the situation on the ground.

[The Chair, Liberal, Sven Spengemann]

Thank you very much to Mr. Bergeron and to the witnesses.

Go ahead, Ms. McPherson. You have six minutes.

Go ahead.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you, Mr. Chair.

I'd like to thank the witnesses for being with us today and for sharing their expertise with us. This has been very interesting.

I will start with Ms. Caprani.

You spoke a little bit about the trickle-down of the impacts on countries, outside of the vaccines. One big concern that I am feeling with this is, first of all, that the world has changed focus. Now that the developed world or the countries in the north have reached fourth doses and have increased their vaccination, there is this feeling that COVID-19 is over and that we can change the channel or turn the page. I think both of our witnesses today have made it very clear that we are not out of this pandemic and that variants will continue to develop.

One worry of mine is that ODA will be impacted. Countries will see their vaccines as a portion of their ODA, which means fewer ODA dollars will be available for things like other health care initiatives, education and support for women and girls.

Can you speak about whether or not that worry is founded, and what we can do to prevent it?

[Lily Caprani]

There are two separate points. The wider impact of the pandemic on developing countries—especially their health systems, but also other essential social sector provision—is an enormous concern, especially for UNICEF, because of the way children are kind of hidden victims of the pandemic. Although they haven't been at greatest risk of severe illness and death from the pandemic, they have suffered from extensive closures of essential services, backsliding of routine immunizations, a lack of access to newborn and maternal health care, and school closures. They really will bear a generational cost of the pandemic response, especially if investments in other forms of ODA are reduced in order to pay for the pandemic response.

The pandemic response needs to be additional to, not instead of, continued and sustained investments in health, education and social protection services. That continues to be in the interest of all high-income countries as well. This should never have been, and is not, a matter of charity or generosity. It's in the enlightened self-interest of all to continue to make these investments.

We're also beginning to see, as I mentioned, alarming backsliding in progress that was hard won over more than a decade. We're seeing the return of outbreaks of other vaccine-preventable diseases, including measles and now polio as well, which have significant knock-on effects on the health system and on communities surrounding those low-coverage areas. This kind of reversal of progress is entirely avoidable. It is a very concerning side effect of not having sustained investment throughout the pandemic.

I don't want to get too far off topic, but we are starting to see the same kinds of worrying trends in the provision of nutrition services, for example, as well.

Yes, it is a huge concern. While we know that the OECD DAC rules allow donor countries to offset some of these pandemic donations and payments against their ODA, we would strongly encourage donor governments not to do so and to recognize the long-term impact that will have on hard-won gains in health and development.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you.

I think it's such an important point that we are talking about “in addition to”, not “instead of”. That's a vital thing that I'll certainly being pushing for.

My next set of questions is for Dr. Berkley.

Dr. Berkley, it's a little bit opaque for us to understand exactly the situation with regard to Canadian doses that have been donated. We have heard that there's a commitment for 200 million doses. We have seen some dollars. The additional dollars in the budget were of course very welcome. The government has talked about giving approximately $87 million to date. Can you give us some actual numbers of where those doses are and what that looks like?

From what I understand, the only ones that I can actually find and put my finger on are those 21,600 doses that went to Madagascar. I would like more clarity on that, if I could.

[Dr. Seth Berkley]

I don't have all the information in front of me. In terms of doses that I am aware of, there were 10 million doses of Moderna that were provided. There were 12 million of J&J, about 22 million doses of AstraZeneca and seven million of NovaVax.

Some of those donations were ultimately returned because of short shelf life, but the vast majority of them have been delivered. I don't have a breakdown in front of me about which countries they went to, but my understanding is that Canada did not earmark those doses, and therefore they went into the general supply for the 92 countries that need it.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

If you could provide those numbers in writing at a later date, that would be fantastic. It does seem like it is a fraction of the doses we would like to see.

The very last question—I know that I'm running out of time—is a very quick question. What would have been the result on the vaccine rollout if the TRIPS waiver had been accepted when South Africa and India asked for it at the very beginning of the pandemic? We're two and half years in and we still have not agreed to that.

What would have been the impacts if we had agreed to that waiver much sooner?

[The Chair, Liberal, Sven Spengemann]

Give just a brief answer, please.

[Dr. Seth Berkley]

None.

The critical issue is know-how. Patents have not been the blocking factor here. Of course, you need to have access to any patents, but they can even be worked around. The critical issue for biologics is know-how. If you don't have the know-how....

Moderna has said that they were not going to block their patents from the beginning, but nobody has been able to make the Moderna vaccine because they don't have the know-how. It's the know-how that's critical.

[The Chair, Liberal, Sven Spengemann]

Thank you so much. Thank you, Ms. McPherson.

We'll now go to our second round. Just in the interest of time, in our second panel, I would suggest that we compress our allocations to four minutes and two minutes, respectively.

If that's okay with colleagues, I would like to ask Mr. Aboultaif to lead us off, please, for four minutes.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Thank you, Chair. Thanks to our witnesses. Thank you again for appearing before the committee this morning.

Dr. Berkley, you mentioned some vaccine brands for which there's less demand, such as AstraZeneca, and that there are some vaccines that were rejected because of short shelf life. Both are actually bad news, because there's a waste there that could be prevented.

First, would you be able to tell us how many vaccinations were rejected due to short shelf life? Where is the deficiency in the system? Is it the infrastructure? Is it the supply chain? What is it that causes that waste of vaccinations?

[Dr. Seth Berkley]

Initially, people were very happy to take any vaccine dose, including those with a short shelf life. There was enormous demand, and people would take them and use them very quickly. What's happened since is that countries have now gotten access to vaccines. With those vaccines being in country, they have planned programs and are working on it. If doses show up that have a short shelf life, they have to either displace the doses that they have planned to use or they have to return those short-shelf-life vaccines.

Some have displaced the vaccines they were planning. Some have rejected them. Of course, if it's coming through COVAX, we don't provide those doses without first asking whether they'll take them, including what the timeline is, but some donors have provided vaccines outside of COVAX with short shelf life and put political pressure on countries to take them. This has meant, if they have short shelf life, that they have to go ahead and push out their other vaccines, which may create problems with those.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Would you have the information, again, on how many of those vaccines were discarded because of that?

[Dr. Seth Berkley]

Yes, we have that information. Do you want it just for Canada, or for COVAX in general?

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

In general, if that's okay. Hopefully it's detailed by country.

Ms. Caprani, you're with UNICEF. I was amazed to hear that some vaccination deliveries did not go well. They were supposed to go to certain countries, especially lower-income ones and middle-income ones. Can you advise us on the supply chain at UNICEF? I believe that an organization so well established must have that readiness.

What was the holdup in not being able to deliver all the vaccinations, especially when they became available?

[Lily Caprani]

UNICEF's supply division is the lead delivery agency for COVAX. That means we are part of the procurement process and of delivery in literal terms, transporting or shipping and flying vaccines to countries. In fact, there is no problem with doing that.

I think there has been a misunderstanding. When we say “delivery challenges”, we don't mean transport problems. Often, the turnaround time between receiving doses, getting them on a plane and delivering them to a country can be as little as 48 hours. There's no constraint in terms of the transportation.

The process involves a country being ready to receive and accept doses. UNICEF will never deliver doses that are ready to be deployed if they can't be accepted by a country and turned into vaccinations received in people's arms. Each country must, of course, tell us it is ready to go before we will deliver vaccines. This is in order to prevent wastage, precisely as we've been discussing.

One way of thinking about it is that we're acting as a matchmaker between available supplies from donors or manufacturers and the receiving countries. As a matchmaker, we have an extremely high success rate. When countries are not able to take those vaccines and deploy them—rejecting them due to short shelf life, or because they simply haven't been able to mobilize a workforce that is ready to go—they will decline. Wherever possible, we'll redirect those vaccines to another country that is ready to deploy them.

Unfortunately, sometimes that does result in waste. Obviously, we aim to minimize that. Thus far it's been very low.