Foreign Affairs Committee on May 9th, 2022

[The Chair, Liberal, Sven Spengemann]

Good morning, colleagues, and welcome to meeting No. 19 ^x of the Standing Committee on Foreign Affairs and International Development.

Pursuant to the motion adopted on January 31, the committee is meeting this morning 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. Simply click on the icon to select a language. For members participating in person, keep in mind the Board of Internal Economy's guidelines for mask use and health protocols.

I would like to take the opportunity to remind all participants that screenshots and taking photos of your screen are 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, I would now like to welcome our witnesses for panel one, who are back before the committee, and to thank them for agreeing to return.

We have with us today from the Ministry of Foreign Affairs of the Plurinational State of Bolivia, Benjamin Juan Carlos Blanco Ferri, vice-minister, foreign trade and integration.

From Doctors Without Borders, we welcome Adam Houston, Medical Policy and Advocacy Officer and Dr. Jason Nickerson, Humanitarian Representative to Canada.

[Chair spoke in Spanish, interpreted as follows:]

Vice-Minister, welcome to the committee. You will have five minutes for your intervention.

[English]

Vice-Minister, we will now go to you for your opening remarks, please.

[Benjamin Blanco Ferri, Vice-Minister, Foreign Trade and Integration, Ministry of Foreign Affairs of the Plurinational State of Bolivia]

[Witness spoke in Spanish, interpreted as follows:]

Good morning, distinguished members of the Standing Committee on Foreign Affairs and International Development of the House of Commons.

I'd first like to thank you for this opportunity to speak, on behalf of my country, about the tremendous injustice that less developed countries have suffered when it comes to the distribution of vaccines.

Thank you for your understanding and for rescheduling this appearance following the death of my father.

In the first stage of the COVID-19 pandemic, vaccines were not available to all. The beneficiaries were the countries with the greatest purchasing power, leaving the less developed countries without the possibility of having the vaccines that would protect people's lives.

Vaccine coverage in the face of global interest meant that vaccines became a market good like any good, thus limiting what should have been a public good. It seems there are people of first and second class, and some people who don't have a right to health or vaccines.

The COVAX mechanism was created with the intention of helping with equitable distribution, but we know that COVAX results haven't been what was hoped for, and still today 20% of the global population hasn't been reached, even though doing so was the goal at the beginning of last year. The developed world began distributing vaccines through COVAX when they were about to expire, vaccines that wouldn't last much longer, to developing countries like ours with many people in rural areas that are difficult to access.

Bolivia trusted in the multilateral plan for global crisis and proposed using the flexibility of compulsory licences contemplated in articles 31 and 31bis of the Agreement on Trade-Related Aspects of Intellectual Property Rights, TRIPS.

To this end, Bolivia has worked with Knowledge Ecology International, KEI, an organization dedicated to accessing medicines and vaccines, with offices in Washington, D.C., and Geneva. KEI collaborates with the Canadian company Biolyse Pharma, which has the capacity to manufacture approximately 20 million COVID-19 vaccines per year. Therefore, this Canadian company could have immunized 20 million people in the world if the compulsory licences had been granted.

Bolivia signed an agreement with this company in May 2021, so they could manufacture and import 50 million Johnson & Johnson single-dose vaccines, and this was subject to obtaining a compulsory licence, which is required to respect TRIPS. A year later many people have died from COVID because they haven't had vaccines in a timely fashion even though the production capacity was there.

Bolivia initiated the compulsory licence process by providing notification of its use as an importing country and requested that Canada, in accordance with its legislation, provide notification of its intention to be an exporting country, which was necessary, and Canada needed to indicate this at the WTO. Biolyse Pharma is based in Canada, so it had to be produced in Canada for this contract to work and for Bolivia to obtain the 50 million doses it needed at the time. The political will of Canada was necessary for this compulsory licence to be effective.

During November and December 2021, the Bolivian position was heard through virtual press conferences and was supported by the Canadian population with 4,500 signatures that made it possible to formalize a petition before the Canadian government's House of Commons. The petition was submitted on December 15, 2021, by member of Parliament Niki Ashton of the New Democratic Party.

The Canadian government's official response noted that Canada is a member of the COVAX mechanism to support countries with difficult access to vaccines and, with respect to the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights, the Canadian government indicated that it would continue to work closely with all WTO members in seeking a consensus-based multilateral outcome to address any intellectual property challenges related to COVID-19.

I want to say clearly that Bolivia is respectful of the response of the Government of Canada. However, Bolivia's request was not to receive vaccines through the COVAX mechanism. Bolivia is already part of COVAX and received a few vaccines through that mechanism, but we could not wait for the consensus of the WTO member countries to change multilateral norms.

Bolivia's request was clear and direct with Canada. It only required the political will to grant the compulsory licence to Biolyse Pharma. Bolivia already had a contract for 15 million vaccine doses, and Bolivia could then have had access to the vaccines. This was when there were no vaccines and Bolivians were dying of COVID. The granting of this compulsory licence would have been proof that the discourse on vaccine equity is accompanied by action.

It could have left an important lesson for international companies that look after only their own economic interests more than public health and people's lives, and for the powerful countries that stockpiled vaccines in the most critical stage of the pandemic, sometimes even letting them expire, leaving the rest of humanity to their fate. This weakens the COVAX mechanism and the spirit of the mechanism due to the lack of availability of vaccines.

Mr. Chair, I want to thank you for having granted this time and space. By way of reflection, what remains for me to say is that the COVID-19 pandemic has changed the life of humanity. We've had social, sanitary and economic crises but, unfortunately, the bureaucracy and the economic interest of some international companies have not changed. The economic interest of profit has won out over human life.

Bolivia had the hope that this path of the use of compulsory licences would mark an alternative to accelerate global vaccination and defeat the COVID-19 pandemic together. It has been shown that the multilateral mechanism, when it comes to intellectual property rights, doesn't work and doesn't provide equitable access to the world's populations.

Thank you very much, Mr. Chair, for this time.

[The Chair, Liberal, Sven Spengemann]

Vice-Minister Blanco Ferri, thank you very much for your opening remarks.

On behalf of the entire committee, I would like to reiterate our deepest condolences and thank you for being with us on this important issue at this difficult time.

Colleagues, Dr. Houston and Dr. Nickerson submitted their opening remarks at the last session. They are available for questions as we go forward.

With that, I would like to go straight into round one.

Colleagues will be familiar with the method of timekeeping at this committee. I'm holding up a 30-second card. When you're within 30 seconds of your questioning or testimony time just keep an eye on the screen. In that respect, it will help us to manage the time we have this morning.

Round one consists of six-minute allocations. Leading us off this morning is Mr. Genuis for six minutes.

Please, go ahead.

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

Thank you very much, Mr. Chair.

Thank you to the witnesses. Doctors Without Borders does incredible work around the world, and it's been my pleasure to engage with them on a broad range of issues.

I want to start my questions with Vice-Minister Blanco Ferri.

Thank you so much for being with us today. I always particularly appreciate when we have the opportunity at the foreign affairs committee to directly engage with leaders and officials from other countries.

I thought your comment was interesting about whether we view vaccines as a market good or a public good.

It seems to me that we are a bit inconsistent, in some ways, in how we treat vaccines. On the one hand, pharmaceutical companies seek protection in terms of intellectual property that comes with being a market good, but in other respects, we've created vaccines like a public good. There have been grants that have been given for the development of vaccines, and also vaccine manufacturers have been protected through indemnification clauses.

We heard previously at this committee that COVAX has an indemnification mechanism, whereby people who bring forward complaints about vaccine injuries can be compensated through a no-fault fund, but industry does not contribute to that fund.

It seems to me that on some level industry gets the benefits of a market goods structure, that is, the protection for intellectual property, while also seeking the benefits of a public goods structure, that is, to be insulated from liability in the event of problems as well as to receive grants for production.

Vice-Minister, I wonder if you can reflect on that question and whether you agree or not with the description I offered.

Also, could you share a bit about how, in practice, the indemnification clauses work for your country? My understanding is that countries are expected to sign on to indemnification agreements if they want to get access to particular vaccines. If they have concerns about the indemnification structure, then they won't be able to access those vaccines. I wonder if you could comment on that and what the process has been like from your end.

[Benjamin Blanco Ferri]

[Member spoke in Spanish, interpreted as follows:]

Thank you very much for the question.

COVID vaccines must be public goods. As we have said, however, these treatments have become commercial products. Of course, the laboratories gave priority to countries that could pay, since there was limited production. Vaccines should be treated as public goods. Vaccination in Bolivia is free for Bolivians without discrimination.

Because of the multilateral trade system, vaccines were not available for less developed countries due to cost. When we wanted to purchase vaccines, it was a problem for Bolivia, which has to be able to respond to any request from a citizen about a vaccine and provide them with a vaccine. In the current system of international companies, we haven't been able to provide these services. We had to sign a contract or we could not get any vaccine. The situation was a difficult one.

These vaccines should be considered—as we consider them—public goods. The current system prevented us from getting vaccines without entering into a contract with these countries. Some providers spoke of having a contract. Others spoke of previous agreements. It was not possible to enter into agreements with those companies.

Thanks to COVAX, we received vaccines from Pfizer. We had to enter into an agreement with the COVAX mechanism, and that was how we got Pfizer. We could not sign direct bilateral agreements with the producers, because that would have threatened our constitutional obligations and abilities.

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

Gracias.

[The Chair, Liberal, Sven Spengemann]

Mr. Genuis, thank you very much. You're at six and a half minutes. We'll have to leave it there in the interest of time. I apologize.

Please go ahead, Mr. Sarai. You have six minutes.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you.

Again, you have my condolences, Mr. Blanco Ferri, on the loss of your father. Thanks for coming back.

My question is for Doctors Without Borders. Maybe Dr. Nickerson can answer this one.

In November 2021, a CARE International presentation highlighted the gender gap in COVID-19 vaccination rates in low- and middle-income countries. In 22 of 24 of the countries in which it operates, CARE noted that women are less likely to be vaccinated and less likely to feel that vaccines are safe. What is more, women make up 70% of health workers worldwide, and are therefore more likely to be in roles that expose them to COVID-19.

Why are women in low- and middle-income countries less likely to be vaccinated than men?

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

Thank you for the question.

Unfortunately, I can't speak specifically to the CARE report because it's their data, their analysis.

What I can say from what we have seen throughout the COVID pandemic is that it has been very much along these lines, and there has been clearly a differentiated impact along the lines of gender in many of the places where we work. For example, at the start of the pandemic, we saw many health services that became suspended either because resources were diverted to COVID-19 response or—and again we've seen this throughout the pandemic—health staff are either sick or infected or have been exposed to COVID-19, and that's led to the closure of many health facilities, the suspension of health activities and so on. Therefore, we have seen throughout the pandemic a significant impact on women, women's health and women's health programming.

As far as COVID vaccination specifically goes, I don't believe we have data on this from our programs, but I'm happy to look into that and get back to the committee.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Would you know how to remove some of those barriers, to remove the hesitancy that women have in those countries?

[Dr. Jason Nickerson]

Yes, absolutely.

In our programs everything we do is done on the basis of a needs assessment. We are an impartial organization. We provide medical assistance on the basis of need alone. A fundamental starting point for any medical intervention that we do is a needs assessment to understand what a community's health needs are, what their priorities are and how we can best meet those needs. Part of doing a needs assessment is, of course, looking at access to health care and understanding what some of the barriers to access are, and that can be done in a number of different ways.

We go to health facilities and we look at who's standing in line. Is there clearly a gender differential in who's accessing health services? We speak with communities to understand what the particular barriers might be for men, women, boys and girls. You look at a number of different factors. Targeting programs to meet the needs of different communities and often structural barriers that different populations may have is absolutely a key part of what we do. It's very nuanced and it's very specific based on different communities, different countries, different populations and so on. There's not a one-size-fits-all model, and that needs to be baked into the process of doing these needs assessments and designing interventions.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you.

Vice-Minister Ferri, according to the our world in data project at the University of Oxford, 61% of the Bolivian population has received at least one dose of COVID-19 vaccine.

How and from whom did the Bolivian government acquire the COVID-19 vaccine doses they've administered so far?

[Benjamin Blanco Ferri]

[Witness spoke in Spanish, interpreted as follows:]

Thank you very much for the questions.

We received vaccines from various sources. In January 2021, we started receiving vaccines from Russia and China. We did this through a bilateral agreement with the heads of state concerned, and there was a great deal of political will to facilitate receipt of vaccines by Bolivia for the vulnerable population and the general population.

Following that we received vaccines from countries like Mexico and Argentina—these are also developing countries—and we received other vaccines as well through the COVAX mechanism, so the bilateral agreements were a major factor in the vaccines we had available. Many of the vaccines we received were provided free of charge; however, their shelf life was very short and they started to expire by August 2021.

I hope I've answered your question.

[The Chair, Liberal, Sven Spengemann]

Mr. Sarai, thank you very much.

We'll have to leave it there, in the interest of time.

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

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

Thank you to the witnesses.

I'd like to continue with Mr. Sarai's question.

Mr. Ferri's answer shows what happens when neglect by western countries unfortunately pushes the developing countries into Russia's and China's embrace, particularly when there is no reliable information about the efficacy of the Chinese and Russian vaccines. I would therefore like to ask Mr. Ferri two questions.

Firstly, why do you think the Canadian Access to Medicines Regime did not function well enough to enable you to quickly obtain vaccines through Biolyse Pharma?

Secondly, did you have discussions with the Canadian government about obtaining some of the additional doses that Canada was planning to give to developing countries, whether on a bilateral basis, or through COVAX?

[Benjamin Blanco Ferri]

[Witness spoke in Spanish, interpreted as follows:]

Thank you very much for the question.

We received many of the vaccines through COVAX, which redistributes the vaccines provided. We received direct supplies of vaccines from any countries that offered them. We have not received any vaccines from Canada, either through COVAX or directly, bilaterally, from Canada. As far as gifts from Mexico or Argentina, that was outside of the COVAX mechanism. Within COVAX, we received no vaccines from Canada.

Now, thanks to the embassy of Canada, we have excellent relations with Canada. However, we have not received any vaccines through COVAX or bilateral agreements.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you.

On the other hand, we still don't understand what failed to work properly with the Canadian Access to Medicines Regime. In any event, there will definitely be other opportunities to look into this matter in greater depth at a later date.

My other question is for the Doctors Without Borders representatives. According to a report published by Doctors Without Borders on April 26, Canada ought to take a position in favour of exemptions from intellectual property agreements. For several weeks now, however, we've been hearing from others who disagree.

Mr. Joshua Tabah, the Director General, Health and Nutrition at the Department of Foreign Affairs, Trade and Development, said to us here on March 21 that the problem was not so much one of supply, but rather one of demand. It would appear that there were problems with getting available vaccines to developing countries. Perhaps Mr. Ferri would also like to comment on what Mr. Tabah said.

On April 25, we welcomed Mr. Seth Berkley, from the Gavi organization, which administers the COVAX initiative. He told us that even if patent restrictions were removed, it would not necessarily facilitate the decentralization of manufacturing to developing countries, because there would be a capacity problem, not only at the industry level, but also in terms of knowledge.

How do you react to these assessments stating that removing restrictions from intellectual property agreements would not necessarily solve any problems, because we are in a different phase now?

[Dr. Jason Nickerson]

Thank you for the question. I'll answer quickly because I think you also wanted Mr. Ferri to jump in.

There are a couple of things.

First of all, I'll say that our position has always been that removing intellectual property barriers was one part of the solution. I think it has always been clear that removing the patent issue from the equation was never going to be entirely sufficient. We have always said that, in addition to this, there needs to be effective technology transfer to manufacturers in low- and middle-income countries. I think it is also clear that there is capacity in countries to produce vaccines if they have the legal right to do so and if the technology is transferred to them along with manufacturing know-how and so on.

I agree—and we said this in our statement as well—that we are in a different phase of the pandemic, where supply is no longer the predominant issue, but that's a relatively recent development. We also have always maintained that what countries needed was a stable, predictable supply of vaccines from the start.

We work in roughly 70 countries around the world, and we supplement and provide vaccination campaigns and activities in many low-income countries. We're familiar with the difficulties of running even basic vaccination campaigns in difficult circumstances. Under-resourced health systems were always going to have a difficult time scaling up vaccination campaigns, but the solution to that was to make vaccines available equitably and throughout the pandemic, so that countries had the ability to scale up their vaccination activities and be able to plan for them and roll them out.

[The Chair, Liberal, Sven Spengemann]

We'll have to leave it there.

Next is Ms. McPherson, please, for six minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much.

I would also like to echo the comments by our chair and express my condolences to Vice-Minister Blanco Ferri.

I think I'd like to start with some questions for you, Vice-Minister, following up on what my colleague Mr. Bergeron talked about.

The Canadian access to medicines regime is the process through which you tried to get that licensing and tried to get the vaccines for the people in Bolivia. Can you talk a bit about the barriers you faced? I know that you spoke about this, but I want all of us to very clearly understand that this is a broken system and that CAMR was not possible for you to work through. How can we make sure it is fixed in future pandemics?

Can you talk about the barriers you faced and whether you would recommend another country to go this route? Also, what can be done to improve the process for CAMR, Canada's access to medicines regime?

[Benjamin Blanco Ferri]

[Witness spoke in Spanish, interpreted as follows:]

Thank you very much.

We began the compulsory licence process, which is part of the multilateral norm, with TRIPS. TRIPS foresees this type of global crisis, this type of emergency, so there is the compulsory licence process and the voluntary licence process.

Bolivia, with this pharmaceutical company based in Canada, Biolyse Pharma.... The first thing it did was to see about the possibility of producing vaccines for us. First they tried to obtain a voluntary licence, to see if they could have the licence without further bureaucracy, because we were in a global crisis. They were not able to obtain that licence directly from Johnson & Johnson, which didn't respond to them, so we went the route of compulsory licences. That's the second mechanism in TRIPS under the World Trade Organization.

This process indicates that you need to have political will from the importing and the exporting country. In the case of Bolivia, we didn't have capacity at that time to produce our own vaccines, so we had to contact this Canadian company.

As an importing country, we notified the WTO, as indicated in the requirements. We said we had requested this and that we all know the pandemic is a global problem and that this mechanism should apply. However, the second part of the mechanism indicates that the exporting country also has to notify of its intention to export under the compulsory licence program. Canada needed to include the vaccines against COVID as part of an annex to products that fall under these compulsory licences. That's why we made the request for Canada to include it in that appendix, which would have meant that Biolyse Pharma would have been able to produce 15 million doses for Bolivia.

We already had the price negotiated with Biolyse Pharma. The only thing we were missing was that licence. It would have been Canada that would notify the WTO that the vaccines could be exported from its country. That's where we ran into difficulty. As I mentioned through press conferences, we received support from Canadians. We gathered 4,500 signatures. There was a petition in the House of Commons. However, the government response went otherwise. They said that they work with COVAX and that, under the WTO, they will continue working with all countries, but they didn't answer us regarding whether they would export the vaccines from Biolyse Pharma.

Basically, it hasn't been possible. We've been waiting for over a year for this authorization, and Bolivia.... I'll echo what the Doctors Without Borders representative said. The problem with supply was last year, when we didn't have direct access to vaccines. Countries like Bolivia didn't have vaccines. For future opportunities, when this type of pandemic or emergency occurs, it's important to be able to modify these processes. National standards shouldn't put bureaucratic obstacles in place.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

I'm sorry to interrupt. I have a just few more seconds, and I wanted to clarify that it was lack of political will. Biolyse was able to produce the vaccine without the tech transfer. The only barrier was on intellectual property.

I want it to be very clear: The government failed to provide that authority. They failed to provide that political will.

Is that accurate?

[Benjamin Blanco Ferri]

[Witness spoke in Spanish, interpreted as follows:]

Yes, that's correct. There was not enough political will for the compulsory licence that would have allowed Bolivia to have 15 million doses of vaccines. Biolyse Pharma was ready to produce them. We had a contract signed with them. The only thing missing was the authorization from the Canadian government, which a year later we still don't have.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

I'm so sorry that people died because of our failure.

[The Chair, Liberal, Sven Spengemann]

Thank you very much.

Thank you, Ms. McPherson and Vice-Minister Blanco Ferri.

Colleagues, this takes us to the end of our scheduled time with this panel. We have a second panel that's waiting to speak to us. We also have some time set aside at the end of the meeting to discuss drafting instructions for the report on this study, which is critical to our pathway towards actually releasing a report before we break.

With the concurrence of the committee, I would like to thank our witnesses in the first panel for being with us.

Vice-Minister Blanco Ferri, Dr. Nickerson and Dr. Houston, thank you all for your time, your expertise and the work that you do. We will let you disconnect and then transition to our second panel.

We will suspend briefly.