Foreign Affairs Committee on May 9th, 2022

[The Chair, Liberal, Sven Spengemann]

I'd now like to welcome the second group of witnesses.

This morning, we are welcoming Dr. Marc-André Gagnon, Associate Professor, School of Public Policy and Administration, Carleton University, and Dr. Madhukar Pai, Canada Research Chair in Epidemiology & Global Health, McGill University.

We will give each of our witnesses five minutes for opening remarks. After that, we will go into questions by members.

For the benefit of our witnesses, I have a manual way of signalling when there are 30 seconds remaining in your questioning or testimony time. Please keep an eye on that card for the purpose of time management.

We will go ahead.

Professor Gagnon, you have the floor now to begin your opening address.

You have five minutes.

[Dr. Marc-André Gagnon, Associate Professor, School of Public Policy and Administration, Carleton University, As an Individual]

Thank you very much.

Thank you for your invitation.

My remarks today will be about intellectual property with respect to COVID‑19 vaccines, and about ways of reviewing institutional structures to make vaccine production faster and more equitable in Canada and abroad during pandemics, and I'm not talking only about COVID‑19.

I have over 150 publications to my credit and my area of specialization is political economy in the pharmaceuticals sector. Apart from my role as an expert witness for Justice Canada in connection with a trial on the regulation of patent medicine prices conducted in 2020 in the Quebec Superior Court, I have no conflicts of interest to declare.

One year ago, I testified before the Standing Committee on International Trade on the issue of suspending certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS, on COVID‑19 technologies. More than a year later, here I am again to discuss the same subject.

Since it was a year ago, allow me to remind you that early on in the COVID‑19 pandemic, it was impressive to see researchers from around the world working together and following open-science principles by systematically exchanging research data, whether to sequence the virus genome, monitor its evolution and its variations, or produce protective and detection equipment.

In May 2020, the World Health Organization, the WHO, established C‑TAP, which stands for the COVID‑19 Technology Access Pool, based on open science principles, to promote the exchange and transfer of technological expertise and knowledge that would help combat COVID 19.

The Medicines Patent Pool, or MPP, funded by Unitaid, also broadened its mandate to allow for the voluntary sharing of patents related to COVID 19.

At the outset, we thought we were headed towards a scientific effort based on technological collaboration and an exchange of data to ensure that every country could maximize its efforts in combatting COVID‑19. Unfortunately, the old proprietary science reflexes based on patents, trade secrets and technological monopolies quickly got the upper hand. No company has yet agreed to reveal its vaccine technologies to C‑TAP or to the MPP. Each company has been working in a silo to maximize future revenue. For example, companies that own vaccines have generally been very reluctant to negotiate licensing agreements that would help boost production.

Open science and patent sharing would be the most effective and equitable ways to optimize the production and distribution of vaccines during a pandemic. The dynamics of vaccine nationalism, which pits countries against one another to obtain vaccines from patent holders, allows these companies to maximize revenue by artificially creating a scarcity of the technologies essential to international public health. Two weeks ago, in response to a request from the Dominican Republic to use compulsory licences for Paxlovid, which is not a vaccine, but a form of treatment, Pfizer argued that intellectual property was a human right. That's total bullshit!

Don't get me wrong, patents represent one of several means to Technical difficulty, and in some circumstances, they are extremely useful. By their definition and nature, patents exist to encourage long-term innovation by slowing down the dissemination of innovations in the short term. During a pandemic or a health emergency, patents are counterproductive and become a barrier to international public health. There are other ways of speeding up the development of new technologies. By eliminating the risks inherent in private investment, measures like public grants and market guarantees have been essential incentives for the development of vaccines to combat COVID‑19.

In that kind of context, patents are superfluous and even harmful to the development of and access to new technologies. Even though governments invested hundreds of billions of dollars on the development of vaccines, we continue to consider it normal for vaccines to remain entirely in the hands of private-sector monopolies. All that a defence of patents does is increase earnings for shareholders by artificially creating scarcity. Don't forget that in 2021, Pfizer doubled its revenue because of its vaccine and tripled its profits. The company also expects to increase its revenue by 25% in 2022.

Every time there is a health emergency or a pandemic, and I'm not just talking about COVID‑19, certain provisions of the TRIPS Agreement should be suspended for relevant technologies and other means should be used to encourage innovation and technological development. In South Africa, for example, reverse engineering had to be done on the Moderna vaccine without any technical assistance from the company. It took several additional months to develop a vaccine similar to Moderna's. An mRNA vaccine to combat COVID 19 was also successfully developed even before the spread of the Omicron variant. However, because the Moderna patent holder refused to release its data, South Africa had to conduct its own clinical trials to obtain the necessary approvals. That led to a delay of several months after the Omicron variant wave before the vaccine could be distributed.

As you have already discussed exemptions from certain provisions of the TRIPS Agreement, I will skip that section.

To conclude, Canada has to stop being part of the problem. Health products for COVID‑19 should be added immediately to schedule 1 of the Patent Act. We need to immediately support an exemption to the TRIPS Agreement for all COVID‑19 treatments and vaccines, and to ensure that such a suspension could readily be triggered for any future pandemics.

And we need to start right now to encourage initiatives that would lead to sharing of open science technologies for all products to combat COVID‑19 and for any health research for which proprietary science has become a barrier to public health.

I'm counting on Canada to get on the right side of history for pandemics. Unfortunately, I have been extremely disappointed so far.

I'd be happy to answer any questions you may have.

[The Chair, Liberal, Sven Spengemann]

Thank you, Professor Gagnon, for appearing and for your opening address this morning.

I would now like to give the floor to Dr. Pai for opening remarks of five minutes. Please go ahead, sir.

[Dr. Madhukar Pai, Canada Research Chair in Epidemiology & Global Health, McGill University, As an Individual]

Thank you very much for giving me this opportunity. I would like to make my remarks about the critical importance of self-sufficiency in vaccine production in all cases.

Firstly, I want to acknowledge that last year, around this time, I was very lucky to get my vaccine shot here in Montreal. I'm extremely grateful to Canada for making that available to all of us. At the same time, India was going through a catastrophic delta wave crisis. I was struggling to reconcile my two worlds, where my family and I, even my child, had easy access to vaccines here, but my friends and family, brothers and sisters, and everyone in India was struggling. In fact, the delta wave ripped through an unvaccinated country. When the dust settled, the WHO just estimated that India may have lost 4.7 million people over two years.

I have no words to capture the devastation. I'm still traumatized by seeing so many people die. I just can't stomach why we would allow country after country to get devastated by this virus. Letting this virus rip through the world is a very bad strategy, and 15 million lives, at a minimum, have been lost. We have to do better than this.

Today India is in a much better place. Why? First, it's because India manufactures its own vaccines. Second, it has vaccinated most Indians, at least with two doses. Why should every country in the world not have the same access in this catastrophic crisis we are facing?

Only 16% of the population of low-income countries have had even one dose. Even as my province, Quebec, just made fourth doses available to me and anyone over the age of 18, I am appalled that nearly three billion people around this world had not even had a single dose of vaccine.

This pandemic is far from over. Please do not believe anyone who is telling you to move on. We cannot move on when this virus is absolutely mutating at a very fast pace. We are already seeing subvariants cause so much damage and new waves. Long COVID is further damage that none of us have really calculated. Allowing this virus to mutate and infect more people will result in long-term consequences for all of us.

We cannot vaccinate just Canada or rich countries and boost our way out of this crisis. Vaccinating the world equitably and distributing tests and antivirals are the only long-lasting solutions for us as Canadians. Let us remember this, please: There is no way out of this mess if we do not equitably vaccinate the world.

I am truly disappointed with what we have done so far. I know, in terms of our intent, our Prime Minister has said explicitly that vaccine equity matters to us as Canadians. In terms of our actions, we only donated 15 million doses. What will we do with all of the extra doses? Last year, when there was so much devastation all around, why did we not donate them and save more lives? Why have we acquired the reputation of being a vaccine hoarder globally? That's not a reputation we want as Canadians. We are better than this.

I want to say that giving money is a great thing. I'm glad we're giving money, but I think every country is now saying that charity is not what they're looking for. They're looking for justice and self-sufficiency. I cannot imagine anyone better than Dr. John Nkengasong with Africa's CDC, who put it so eloquently in one of his articles. He said, “Never ever should we have had to keep counting on externalities to take care of our own security needs. A key pathway for collective global security is an Africa that is self-sufficient.”

Self-sufficiency is something we should get as Canadians. Why? In the early days of the pandemic we had no Canadian vaccine. We had no ability to manufacture. We were at the bottom of the list and were desperately looking for shipments from Moderna and Pfizer, and from all parts of the world. Today we have a Canadian vaccine. We are starting manufacturing in Montreal. We are investing in domestic manufacturing. Now please tell me why other countries don't deserve to do the same. If we believe in vaccine self-sufficiency, why should every country in the world not aspire to have their own ability to make antivirals, tests and vaccines?

Our lack of TRIPS waiver action is disappointing to me for that reason. A TRIPS waiver alone is not enough, but in combination with tech transfers, mRNA hubs and other initiatives by the WHO and others, it can completely change the game not only in this pandemic but also for future crises.

The best way to protect the world is to have as many countries in the world be self-sufficient in terms of their own ability to make vaccines, tests and antivirals.

In closing, I would love for us to do three things as Canadians.

Immediately and publicly back the TRIPS IP waiver, not only for vaccines but also for tests and antivirals.

We must also fund the WHO and the African Union to develop their own mRNA hubs and promote self-sufficiency. Vaccine self-sufficiency by other countries should be our explicit stated goal. That is what will keep us safe, not only now but in the future. Let's please donate and honour our pledge for 200 million doses. Let's do it and put a timeline on it. Within the next six months, I would love to see all 200 million doses successfully donated. Also, let's provide more funding for vaccine delivery so that we can support our accelerator and other initiatives.

Lastly, even as rich countries are declaring the pandemic over and cutting back on funds for global vaccination efforts—as the White House is doing—the scientific model and economic case for vaccine equity remains extraordinarily powerful. Please, Canada, let us do the right thing.

Thank you.

[The Chair, Liberal, Sven Spengemann]

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

We'll go straight into round one, with six-minute allocations to start. Leading us off is Mr. Chong.

Please go ahead.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

Thank you, Mr. Chair.

I'm just going to take a minute before, through you, I pass the floor over to Mr. Morantz.

I want to give notice of a motion for consideration at Thursday's meeting, and I would ask if you could set aside the final 10 minutes of that meeting for consideration of the motion I'm going to give notice for. It is:

That the Standing Committee on Foreign Affairs and International Development support the full participation of Taiwan in the International Civil Aviation Organization and its 41st Triennial Assembly to be held on September 27, 2022 – October 14, 2022; that this be reported to the House as soon as possible; and that the committee request a government response.

It's very similar to a notice of motion I gave some time ago, but it adds to it the clause that the committee request a government response, which would preclude us from moving concurrence in the House for four months and, hopefully, will allow all members of the committee to support this motion on Thursday.

Thank you, Mr. Chair. That's all I wanted to do at today's meeting.

[The Chair, Liberal, Sven Spengemann]

Thank you, Mr. Chong.

Am I correct that you're delegating the rest of this time to Mr. Morantz?

You have about four and a half minutes left in the allocation.

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

Thank you, Mr. Chair.

Dr. Pai, I take your point with respect to domestic capacity. I know that the Government of Canada made a SIF grant of $173 million for that purpose to a company called Medicago. The problem is that they developed a vaccine, the Covifenz vaccine—and you may be aware of this issue—but when they applied to the World Health Organization for an emergency permit, they were denied.

They were denied because the Philip Morris tobacco company has a major stake in Medicago, and the World Health Organization has a policy that they won't do business with tobacco companies. Do you see this as a failure of due diligence on the part of the Government of Canada and a misstep in terms of trying not only to develop domestic capacity but to meet our COVAX obligations as well?

[Dr. Madhukar Pai]

Thank you, sir.

I am pretty sure.... I'm not an expert in tobacco, but the tobacco regulation that all UN agencies have to comply with is very old. It wasn't developed just around COVID. In other words, if anyone would have done their due diligence, they should have picked up that tobacco company involvement in it would eventually hit against the UN policy or regulation.

At a minimum, just by calling the WHO and asking them, “If this were to be developed and a tobacco company were involved, what would happen to the approval?”, they would have learned very quickly that it might not be approved, in which case the government could have then invested the money in some other deserving company.

All I would say is, we should have anticipated this.

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

Thank you for that important response.

Dr. Gagnon, I just wanted to clarify. You made a comment with respect to patent holders maximizing their revenue throughout this whole COVID episode, but there's a CARE report out that says that for every $1 donors spend on vaccine doses, they're spending roughly $5 on actually delivering the vaccine.

It seems to me that for those two things, the cost of delivery, if not equal to, is actually even more important than the cost of donating the vaccine. Have you done any research on, or do you have any concerns over, why it costs so much to deliver these vaccines?

[Dr. Marc-André Gagnon]

We're talking about the cost of donating the vaccine. That is, basically, the manufacturing cost and the money that goes to the company versus what needs to be paid for delivery—getting the vaccine into the arms of people.

The issue of intellectual property is not based on the problem of distribution costs, but these are important costs that need to be taken into account when we provide donations. It's not just about shipping over stacks of vaccines. It's about making sure that we're helping different countries that are able to run vaccination campaigns in a proper way.

Keep in mind that just giving away the vaccines we don't want, such as AstraZeneca, for example.... When we saw there were safety issues with AstraZeneca, we said, “Okay, now we're going to give this away and—”

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

I'm sorry to interrupt. I have such limited time. I do appreciate the response, though.

I have one quick question for either of you.

The WHO reports that 6.24 million people have died from COVID-19. I know that Dr. Pai mentioned it is more like 12 million. The Economist has its own analysis, which shows that COVID-19 deaths are, in fact, far higher than officially reported numbers. Its estimate is based on tracking excess deaths over the baseline norm.

I'm wondering if you could comment on which number, in your opinion, is more accurate. Is it the WHO's 6.24 million or the 21.2 million that The Economist predicted?

[The Chair, Liberal, Sven Spengemann]

Mr. Morantz, we're out of time in this round.

Very briefly, perhaps either witness can just answer A or B, or submit their thoughts in writing. That's acceptable, as well.

[Dr. Madhukar Pai]

The WHO just published an excess death report last week, and their estimate is closer to 15 million than six million. I think everybody in the world agrees that everybody is undercounting the number of COVID-19 deaths. The reality is somewhere around 15 million.

[The Chair, Liberal, Sven Spengemann]

Thank you very much.

Dr. Fry, please go ahead for six minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Mr. Chair.

I want to thank everyone for coming. It's nice to see Marc-André Gagnon here with us again, because he's such an expert on so many things. I really respect his thinking and the work he's doing.

I want to ask a couple of questions.

We're talking about the compromise. I want to talk about the compromise text and the fact that the United States, the European Union, India and South Africa are having trouble coming to grips with getting this compromise text done.

First and foremost, the whole concept included more than just vaccines. We talk a lot about vaccines, but I think we need to talk about testing, tracking and surveillance. How do we know if it's 15 million or six million deaths? If you're not testing, tracking and surveilling, how do you know what cases you have? That's my first question.

The second one is, why are treatments being left out of this agreement? How does this compromise fail to address the non-IP components or trade secrets? What can we do to move this along? What can Canada do to get this compromise agreement passed? What are the stumbling blocks? Do any of you know?

[Dr. Marc-André Gagnon]

I can jump in, if you like.

This is an important question. Let's keep in mind that the compromise text is a compromise in a way I consider to be very problematic. We're just focusing on article 31 of TRIPS and putting aside article 39, which is about non-IP or trade secrets. This is unfortunate, especially because, in the last 20 years, there has been an evolution in the organization of intellectual property and patents, where, more and more, the patent offers very little understanding of the technology itself and is way more focused on trade secrets.

The thing is, if you give away the recipe without the trade secrets that go along with it, when the trade secrets have become a central part of your capacity to produce the technology to vaccine, in the end, this compromise will not go very far.

What's important during times of pandemic? We're talking about COVID-19. We could have a new variant emerge that is very bad and the vaccine could stop working. Then we will be in the same movie again. We could have a different pandemic—ebola, for example.

We need to prepare for a capacity of sharing both the know-how and the technology. This is in article 39, which is excluded from the compromise. As well, we need to make sure that if there is help and technology transfer among countries, this will not bring a rainfall of lawsuits and litigation.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you. I want to ask another question.

We are studying vaccine distribution, but there is the whole issue, for instance, of testing and tracking and surveillance. However, we've been told by some witnesses that it isn't about vaccine supply anymore. It's about how countries that get the vaccines can distribute them and can make it happen. We're talking here about basic infrastructure, about personnel to give vaccines. We're talking about a whole lot of things.

Why aren't we focusing a lot on that and on the issue of therapeutics? If you're trying to get vaccines now, when the pandemic is on, it's like closing the door after the horse has run off. We need to be focusing on things like therapeutics.

What do you advise that Canada should do in looking at providing infrastructure for distribution of vaccines within the country of reception, and what are we going to do about things like therapeutics? How are we going to push that forward?

[Dr. Madhukar Pai]

Go ahead, Marc-André. I will go after you.

[Dr. Marc-André Gagnon]

One element I would like to bring in, which for me is important, is that the WHO has this little organization when it comes to flu, which is called the global influenza surveillance and response network. Basically, they're taking care of seasonal flu. The whole organization is working with different countries. Everything is open science. Everything is in calibration. This is the best way to do the screening and monitoring of what's going on, and the evolution of the different diseases. This is working very well. This is the type of infrastructure we needed from the start when it came to COVID-19, and when it comes to other influenza pandemics as well.

One great example is this global influenza surveillance and response network at the WHO.

[Hedy Fry, Liberal, Vancouver Centre, BC]

That's about that, but what about the issue of therapeutics? I'm focusing on that because we need to treat people faster now, rather than trying to prevent the virus from spreading. I mean, it's already spread.

[Dr. Marc-André Gagnon]

When it comes to therapeutics, I mentioned there's the C-TAP to develop the technology. The MPP is a patent pool from Unitaid, but it is a voluntary patent pool.

Both Merck and Pfizer have been using this—for example, Pfizer with Paxlovid—but at the same time, they can impose the conditions. Basically they said they would exchange the technology and make the patent accessible, but only for low-income countries under specific conditions. When Dominican Republic said that it wanted to use the compulsory licence for the therapeutic Paxlovid, Pfizer simply refused, claiming that this was their human right to decide what they want to do. This is nonsense.

[The Chair, Liberal, Sven Spengemann]

Thank you, Ms. Fry, Mr. Gagnon and the other witnesses.

Mr. Bergeron, you have the floor for six minutes.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

I would also like to thank the witnesses for being here today and for sharing their informative comments with us.

Mr. Gagnon, I'd like to begin with a question that has already drawn your attention, and the attention of one of the witnesses we heard earlier, a representative of Doctors Without Borders.

My question is about the grants that would have been required, and paid for by Canada, for the development of lipid nanoparticle technology, and created by spinoff companies from the University of British Columbia.

In that event, I'd like to quote the following: "If most of the funding for designing vaccines comes from public sources, and the price includes a premium for patents, are we not paying for the vaccine twice?"

That's a question I raised with the president of AstraZeneca at a meeting held on April 25. I asked her whether AstraZeneca had supplied its vaccine in quantities equal to the grants paid, and had decided to make the vaccine profitable only once the grants had been repaid. I was not really given a proper answer to the question. I was rather told that they were continuing to give the vaccine to developing countries, but charging for it in developed countries in order to make it somewhat profitable.

What do you think about this response from AstraZeneca?

What do you think about the possibility that we could have also funded research and development into lipid nanoparticle vaccines?

[Dr. Marc-André Gagnon]

We're talking about the AstraZeneca vaccine, but it's important to mention that it was the Oxford University vaccine, which was transferred to AstraZeneca under certain specific conditions set out in the licensing contract. These conditions made AstraZeneca the only company for which some technology transfer had been requested, which did happen. It had also agreed to sell its vaccine at cost for as long as the pandemic lasted. The first time I saw a press release saying that the COVID‑19 pandemic was over, and described as only endemic, was in an AstraZeneca press release. It was very quick to say that the pandemic over, which was rather peculiar.

It's important to understand that for patents, it's not a single company that creates a technology. There are networks of corporations working on the same things. How the patent network is organized is therefore important.

The University of British Columbia's technology became the property of the Canadian firm Genevant, which owns many of the patents Technical difficulty presented with someone from Providence Therapeutics…