Foreign Affairs Committee on April 28th, 2022

[The Chair, Liberal, Sven Spengemann]

Respected colleagues, good afternoon.

I call the meeting to order.

Welcome to meeting number 16 of the Standing Committee on Foreign Affairs and International Development.

Pursuant to the motion adopted on January 31, 2022, the committee is meeting for its study on vaccine equity and intellectual property rights.

[Marty Morantz, Charleswood—St. James—Assiniboia—Headingley, CPC]

Mr. Chair—

[The Chair, Liberal, Sven Spengemann]

Is this on a point of order? Let me finish my opening remarks, if that's okay. Thank you, Mr. Morantz.

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

I take this opportunity to remind everyone that screenshots or taking photos of your screen is not permitted.

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

I also remind you that all comments by members and witnesses must be addressed through the chair.

I would like to now welcome our witnesses. I'll then turn it over to Mr. Morantz if it's a point of order, before we get started, but I'd like to make the introductions.

Colleagues, we have with us this afternoon from CARE Canada, Dr. Ihlas Altinci, sexual and reproductive health technical adviser.

Thank you very much, Doctor, for joining us late in the day, your time. It's very much appreciated.

We also have Nicole Tobin, head of programs in global health. From Doctors Without Borders, we have Dr. Adam Houston, medical policy and advocacy officer, and Dr. Jason Nickerson, humanitarian representative to Canada. From the Economist Intelligence Unit, we have Ana Nicholls, director of industry analysis. Welcome and thank you.

We will give the floor to each of the three groups for five minutes for opening remarks, beginning with CARE Canada.

One more time, Mr. Morantz, is it related to the discussion or is it something else?

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

It's not a point of order. It's a matter I wanted to raise.

[The Chair, Liberal, Sven Spengemann]

Can you raise it during the allocation of time, if that's convenient?

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Sure.

[The Chair, Liberal, Sven Spengemann]

I understand that CARE Canada will lead us off and will be splitting their opening remarks of five minutes between the two representatives. I will give the floor to CARE Canada.

Before we start, I have a very manual way of signalling when you have 30 seconds left in your testimony or members' questioning time, so please keep an eye on this virtually, as you can.

It's over to CARE Canada, please, for opening remarks.

[Nicole Tobin, Head of Programs, Global Health , CARE Canada]

Thanks so much, and good afternoon—

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

I have a point of order.

[The Chair, Liberal, Sven Spengemann]

I'm sorry. Is there point of order?

Go ahead, Monsieur Godin.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

I have not had a chance to do a sound test. So I would like to make sure that everything is working well on the technical side and that you can hear me well. I can hear you very well.

[The Chair, Liberal, Sven Spengemann]

I also hear you well.

[Joël Godin, Conservative, Portneuf—Jacques-Cartier, QC]

Thank you.

[The Chair, Liberal, Sven Spengemann]

We'll go back to CARE Canada, please.

[Nicole Tobin]

Thank you. Good afternoon.

From our offices on the unceded and unsurrendered territory of the Algonquin Anishinabe nation, I thank the committee for inviting us to appear as part of this study.

My name is Nicole Tobin, head of global health programs at CARE Canada.

Gender justice is at the heart of all the humanitarian and development work we do in the CARE confederation. Health gains have been threatened by intersecting crises of COVID, conflict and climate. Women's leadership is essential to rebuild health systems that ensure access to life-saving services for all.

CARE joins Canadian civil society in calling on Canada to work for a consensus at the WTO to improve the compromised TRIPS waiver proposal that was recently tabled. Today, we are invited to testify regarding the equitable delivery of vaccine supplies, focusing on gender.

I'm really pleased to introduce you to Dr. Ihlas Altinci, sexual reproductive health adviser, based in Gaziantep, Turkey, with work in Syria.

[Dr. Ihlas Altinci, Sexual and Reproductive Health Technical Advisor, CARE Canada]

Thank you very much and I also thank you for this opportunity.

Addressing intellectual property rights to improve global access to supplies is essential and must be accompanied by investment in health systems and health workers to deliver those supplies. The CARE confederation has reached 15.7 million people in 53 countries with our COVID programming. Though each context varies, CARE's analysis indicates that the true cost is often much higher than the global estimates account for, when factoring in health workforce and community readiness costs.

Vaccine equity requires targeted and increased investment in delivery. In April, CARE testified to the UN Security Council on vaccine equity gaps in humanitarian settings.

Today I will provide testimony using northwest Syria as a case study regarding vaccine equity and focus on awareness raising. I will give a brief description of the Syrian context.

Compared to the global and Canadian populations, few Syrians have been vaccinated. Only about 9% of the total Syrian population have received one dose and only about 5% are fully vaccinated.

In Syria, COVID is at the bottom of the list of priorities. People face so many hardships including shelling, violence and lack of food and shelter, let alone COVID masks. They live in tents or improvised shelters and cannot socially distance. However, it's positive that 70% of health and humanitarian workers in Syria are fully vaccinated now.

In our context, there's a critical shortage of all health staff. They work long hours in difficult conditions and most health facilities are improvised. They could be in a house, an abandoned building or a school, and they're not equipped as a normal hospital or health facility is. The health and safety of those workers are constantly at risk. They lack consistent access to personal protective equipment. Early in the pandemic they lacked basic leave. Sometimes staff would even conceal symptoms so they would not lose pay.

Because they work in such contexts, some are threatened, beaten or even stabbed, yet health workers—over 70% of whom are women at the global level—are the key to equitable vaccine delivery. Trusted providers can reach underserved communities, doing door-to-door and in-person communication to build vaccine acceptance. They are trusted because they meet families' holistic health needs, including childhood immunization and reproductive and maternal health care. It's very important to have women vaccinators who are more likely to be trusted by women patients.

To achieve vaccine equity, these are my key recommendations.

It's critically important that all actors invest in equitable health systems delivery. We ask that Canada adequately and consistently fund frontline and community health care workers and the organizations they work for.

We must also ensure that there are consistent norms and standards to ensure fair pay and safe and supportive working conditions for all health workers, including humanitarian responses. This includes ensuring they have access to personal protective equipment, testing and treatment, vaccines and paid sick leave.

Finally, to ensure that health workers and their organizations have meaningful roles in decision-making as well as the delivery of the COVID vaccine rollout, their leadership and expertise must drive decision-making for health care delivery in crisis settings. They can address hesitancy and gender-related disparities in access to COVID information and services, including collecting and using sex, age and gender disaggregated data. They can also develop strategies to specifically reach women and other marginalized populations.

Thank you.

[The Chair, Liberal, Sven Spengemann]

Thank you so much, Dr. Altinci, for your opening remarks.

We will now go to Doctors Without Borders for five minutes. I understand Dr. Nickerson will deliver remarks.

Please go ahead.

[Dr. Jason Nickerson, Humanitarian Representative to Canada, Doctors Without Borders]

Thank you very much, and thank you for having us.

Doctors without Borders, or Médecins Sans Frontières, MSF, has been on the front lines of responding to medical needs created or worsened by armed conflicts, natural disasters and disease epidemics for more than 50 years. This experience has, of course, informed our response to the COVID pandemic.

Even before vaccines became available, we urged countries and the pharmaceutical industry to remove intellectual property barriers for COVID medical technologies and to prioritize the delivery of safe and effective COVID vaccines to health workers and vulnerable people around the world. We urged this because for decades MSF has seen how patents can create barriers between vital medicines and patients who need them for diseases like HIV and tuberculosis. We knew full well that the risk of effective vaccines becoming inaccessible to people in low- and middle-income countries was high.

As you know, this inequity came to be and COVID-19 continues to circulate and evolve, while vaccines remain out of reach for many.

We want to emphasize that inequitable global access to medicines due to intellectual property barriers is not unique to COVID-19. In fact, inequitable access to COVID vaccines is a symptom of dysfunctional pharmaceutical research and development and distribution systems. Therefore, today's conversation needs to extend beyond what needs to happen right now for this pandemic to broader questions about intellectual property and access to medicines for the future.

This conversation also takes place against the backdrop of broader reforms to international law, and particularly a pandemic treaty in the early stages of negotiation under the WHO. The shadow of vaccine inequity hangs over these negotiations. Canada's actions and inactions on vaccines may very well influence how it is perceived by other countries at the pandemic treaty negotiating table.

To this end, the failure of the international community to come to an agreement on the narrow issue of a time-limited loosening of intellectual property rules during the pandemic, exemplified by the TRIPS waiver, first proposed in the fall of 2020 and still unresolved today, is not a promising sign. Nor is Canada's refusal to adopt a public stance on this issue.

A sizable majority of countries, more than 100, voiced support for the TRIPS waiver. Canada appears to have kicked the can down the road for 18 months, seemingly hoping the problem would resolve itself.

While today global vaccine supply is no longer the predominant barrier to access that it was six months ago, intellectual property does continue to be a barrier to accessing other COVID tools like therapeutic drugs, and will be a problem in future pandemics.

Canada and the world need to do considerably more to promote access to vaccine technologies, not only for COVID-19 but for other diseases both old and new. We know there will be more pandemics. We know that there are diseases that exist today that have pandemic potential, for which there are no vaccines and no effective treatments and little in the pipeline. Canada has supported good work on vaccine and therapeutics development, but the reality is that these investments often lead to technologies that are not developed beyond their early stages because of a lack of funding or commercial interest. Consider the Canadian-discovered Ebola vaccine that sat on a shelf for years.

Otherwise, if they are developed further, they end up priced out of reach of patients and health systems because Canada refuses to demand that medicines and vaccines developed with public funds be made affordable and accessible when they come to market, including for Canadians. This is bad public health but also, frankly, bad business. A vital guiding principle should be that public investments for public health should, first and foremost, yield public benefits. They should not be subsidies for incredibly profitable companies that ultimately retain all decision-making over affordability and access.

Canada's renewed support for both R and D and domestic manufacturing are welcome, but it should come with strings attached. The outcome should be measured not in dollars earned but in lives saved.

One area where Canada can do something positive is in relation to the Canadian-developed technology that has proven crucial to the pandemic response. The lipid nanoparticle technology underpinning mRNA vaccines, like Pfizer and Moderna, was invented in Canada by companies spun off from the University of British Columbia. Canada should be proud of this achievement, but more than that, Canada should be making sure life-saving Canadian technology gets to all who need it. Instead, Canada has been bizarrely silent on technology transfer of lipid nanoparticle technology. To encourage such transfer, Canada could be using sticks, it could be using carrots or a combination of the two. At the moment we're hearing crickets.

We need to continue to push to ensure that people everywhere are protected against COVID-19, but we also need to be preparing for future pandemics by learning lessons of what's worked and what hasn't over the past two and a half years.

We're happy to answer your questions. Thank you.

[The Chair, Liberal, Sven Spengemann]

Dr. Nickerson, thank you very much for your opening remarks.

We will now go to the Economist Intelligence Unit and Ms. Nicholls.

Ms. Nicholls, thank you also for being with us very late in your day, and thank you for spending time with us on this very important issue.

I will pass it over to you for five minutes of opening remarks, please.

[Ana Nicholls, Director, Industry Analysis, Economist Intelligence Unit]

Good morning. Thank you very much for inviting me as a witness for your inquiry.

I'm sure you've heard plenty of evidence during these hearings about the inequity of the global vaccine rollout. I have to say that this inequity was predictable. The Economist Group forecast it back in May 2020, when the vaccines were still being developed. A subsequent map we published that forecast that low-income countries would not see large-scale vaccination until 2023 or beyond went viral, because it was so controversial. It has since been vindicated by events.

There were many reasons for our prediction. One was the funding and purchase deals that were being used to support the research and to secure early supplies. We realized that global supplies would be slow to ramp up, prompting vaccine hoarding. We expected bottlenecks in shipping and logistics, as well as delivery difficulties at the local level, particularly in countries with weak health care systems. Finally, we reckoned on vaccine hesitancy reducing uptake in many countries to differing degrees.

In reality, the vaccine rollout has been quicker than we expected in some countries. UAE, Rwanda and Cambodia spring to mind. COVAX has been one reason for this, but so have the efforts of these countries as well as vaccine donations by other governments and institutions, including Canada. Nevertheless, there are still 2.7 billion people across the world who are unvaccinated. Most of them live in low-income economies.

Other witnesses have spoken about the health impacts of this unequal vaccine rollout, including the room it leaves for dangerous COVID mutations. The Economist Group has also highlighted the economic impact. We predicted in September 2021 that vaccine inequity would cost the world $2.3 trillion in lost GDP, with poor countries bearing the brunt of that. Over the four years from 2022 to 2025, we predicted that sub-Saharan Africa would lose around 2.9% of GDP as a result of low vaccination rates. The Middle East and Africa would lose 1.4% of GDP, and Asia-Pacific 1.3%. In contrast, losses in other regions, such as North America and Europe, would be minimal.

These forecasts point to the severe economic as well as health impacts of vaccine inequity, but the question the panel is looking at is whether intellectual property rights played a crucial role in this inequity, and whether global relaxation of patent rights would help.

Although companies such as Moderna have said that they would not enforce patents during the pandemic, proponents of the waiver have argued that it would give legal security to generic producers. However, I doubt that a waiver would have prevented the lack of global vaccine supplies that was the main source of inequity in 2021. The right to produce innovative medicines can be protected in three ways—through patents and IP rights, but also, in most countries, through marketing exclusivity and data exclusivity rights.

What are all these protections protecting? They're not just legal barriers. They're essentially about the protection of knowledge. This includes the technical knowledge about the formulation but also the somewhat unwritten understanding about the production process. I would argue that this knowledge can be acquired only through technology transfer, which requires long-term buy-in and co-operation from the original developer. That co-operation would not be forthcoming if IP rights were waived against their will.

I base this opinion partly on my experience in speaking to companies in developing markets about previous efforts to waive patents under TRIPS—for example, in Brazil, in the legislation allowing compulsory licensing, which was strengthened during the pandemic. Despite this, the country's pharmaceutical companies have in recent years preferred to use voluntary licences negotiated with the patent holder, because it gives them access to that knowledge and technology transfer. Fiocruz, for example, struck a deal with AstraZeneca that has allowed it not only to produce that vaccine but also to develop its own.

Technology transfer takes time, and so does ramping up production. That proved very difficult at first during the pandemic, partly because of global shortages of active pharmaceutical ingredients. However, more recently these voluntary licensing deals or contracts, supported by various government institutions, have been successful in raising global output of COVID vaccines. As other witnesses have noticed, supply is no longer a barrier to the vaccine rollout.

I do believe, furthermore, that the IP protections were helpful to the innovation that produced these vaccines in the first place. Some of the more publicly funded vaccines, including the Russian, Chinese and Oxford-AstraZeneca vaccines, did have less of a commercial imperative.

However, the mRNA and other technologies behind the Pfizer and Moderna vaccines were largely developed in the commercial realm in the decades before COVID.

According to a report in Nature, by 2019 there were already 130 mRNA patents, of which 70% were filed by industry, notably by Moderna, CureVac, BioNTech and GSK. The reason these companies invested in this research for decades was because these technologies have wide potential, well beyond COVID. These mRNA technologies can be used to combat other infectious diseases such as HIV, as well as cancer and genetic disorders.

That is why I would argue that waving patent protections for COVID vaccines, against the wishes of the patent holders, would not help with vaccine inequity because it would deter the transfer of knowledge. It could also adversely affect future innovation in life-saving medicines if investors felt the patents were not secure.

[The Chair, Liberal, Sven Spengemann]

Ms. Nicholls, thank you very much for your opening remarks.

We will now go to round one of questions by members. These are segments that are timed at six minutes each. Leading us off will be Mr. Morantz for six minutes.

Please go ahead.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

I'll be using my time to introduce a motion.

The motion is related to Mr. Chong's Winnipeg lab motion. As I understand it, Mr. Chong spoke with you, Mr. Chair, on Monday and asked that you set aside one hour on Friday, which is tomorrow, to consider the matter. You declined this reasonable request.

Second, I emailed you yesterday asking you to set aside the last 15 minutes of this meeting to consider the matter of the Winnipeg lab motion, and I've not yet had the courtesy of a reply.

In the meantime, your government has announced a new non-parliamentary committee that has no obligation to Parliament, to report to Parliament or to be guided by Parliament. It is to be governed by retired justices and not elected Parliamentarians.

[Rachel Bendayan, Liberal, Outremont, QC]

I have a point of order, Mr. Chair.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

This, in my view, is an affront—

[The Chair, Liberal, Sven Spengemann]

Mr. Morantz, may I interrupt you for one second?

There's a point of order. We'll hear that point of order and then go back to you.