Health Committee on Oct. 26th, 2009

[The Chair, Conservative, Joy Smith]

Dr. Butler-Jones will have to answer your question, Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I'd just like some answers to those questions.

[Dr. David Butler-Jones]

Those trials are coming in, and it really relates to dose. The recommendation from our expert committee, because of seasonal flu, was that normally children who are under the age of 10 need two half doses in order to produce immunity. From the initial trials, it looks like maybe one dose will be sufficient. So that's actually good news, but you shouldn't wait to start protecting people until you know whether you need one or two doses. If you know you need at least one, you start with that, and then you make the decision about a second dose when you have that information, which is starting to come in now.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

I'm sorry, did you want to add something?

[Elwyn Griffiths]

Could I add on to that?

There were data also from the prototype vaccine in the younger age groups coming in as well.There were half doses there, so we did have an idea coming in for that. The reason we went forward so quickly was that we could see from this first dose that there was sufficient immunity to go on; otherwise, we would have had to wait until November to get the results of the final study.

[The Chair, Conservative, Joy Smith]

Thank you for adding that, Dr. Griffiths.

We'll now go to Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

Certainly it always strikes me that the older we are the better memories we have of significant diseases from our past that have impacted our families and communities. I think sometimes we forget how important these developments have been, and we tend to lose sight of what happens without immunization, the haemophilus being one that I clearly remember--very grave.

What Dr. Kumar said here a week or two ago when he talked about seeing a couple of young people in his intensive care unit with preventable diseases struck home to me. In a way, his image was very powerful. I think we forget about herd immunity and how well people are protected by the majority taking the vaccine.

Having said that, my first question would be for Dr. Griffiths. Could you elaborate a little bit further in terms of the process for our authorization? Of course, we Canadians, I've noted, in the media have compared ourselves with the United States and said they're earlier. Perhaps you could talk a little bit about the different processes between Canada and the United States.

[Elwyn Griffiths]

The process is not much different. They went forward in the United States; they decided to go for an unadjuvanted vaccine. I can't speak to the details they have. The manufacturers clearly had provided them with sufficient information for them to make a strain change from their seasonal vaccine into their pandemic vaccine, and so that enabled them to license early. But licensing is quite a different thing from actually producing sufficient vaccine for general use. The fact that they can license something doesn't necessarily mean that they have enough material to produce.

In Canada, though, we were actually going for this. We can only work on the data that are submitted to us. The regulator has to wait for data to come in from the manufacturer. As we've just discussed a few minutes ago, we were waiting for data to come in before we could actually license this product.

If there were a situation in Canada, for example, where this disease got really severe in September, then an emergency use order would likely have been instigated, run into an order. You really have to balance the absolute need for the product, in this case for the pandemic early on, versus waiting for data. I think you judge it by how much information you really need, and then you balance what the need is for the vaccine and move forward.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Dr. Butler-Jones, would you care to comment about the differences between the two countries, the U.S. and Canada?

[Dr. David Butler-Jones]

Each country, really every country in the world, is trying to address this as best they can with the tools at hand. The Americans chose to go with an unadjuvanted vaccine. We, along with most of the Europeans, chose an adjuvanted vaccine. In our view, it has greater prospects for better immunity, as well as making additional vaccine available internationally as a result of that.

To get back to your thing, immunization has transformed the face of childhood. When I was a kid, hospitals were full of kids with the complications of measles, whooping cough, and polio, etc. We've essentially wiped that out.

In the context of this disease that we're facing now, basically there are only two ways to stop the pandemic: either we're not immunized, and so all of us who are susceptible get it--so potentially 10 million of us--or we're immunized. There have been concerns, because back in 1976 there was not actually a pandemic but a large number of Americans were immunized. So you were facing a non-disease and there were about 12 per million people immunized who developed Guillain-Barré. That is set against a background of 10 to 20 per million every single year who get Guillain-Barré from some other cause, mostly campylobacter and other infections, and we have not seen that since. It's not clear whether it was even related to the vaccine of the day, given that it's pretty much the background rate.

If we don't immunize, we will see between 400 and 700 cases of Guillain-Barré from disease, from influenza, because the rates are 40 to 70 per million, not the one per million of severe risk, plus 100,000 in hospital, thousands dead, etc. So the risk ratio in terms of vaccine is very simple: the risk of not being immunized is huge.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Of course we have the adjuvanted vaccine, and as you look at it, it seems like very innocent kinds of ingredients. I'm sure it would require a lot of technical talk, but what is it about rose oil or fish oil and water and oil that create that? Again, it might be a little too technical.

[Dr. David Butler-Jones]

Oh no, it's just go figure.

Manufacturers of vaccines have been using adjuvants since the 1920s. A common one has been alum. Partly it's recognizing it and trying different things and finding that it actually increases a person's immunity with a smaller dose. So in terms of the trade-offs, you actually need less virus to produce a vaccine that allows us to develop immunity and protection against it.

I don't know whether you can speak to how it was discovered, but they're constantly trying different things so we can actually improve immunity.There are other things that can improve immunity, which people do, but in a vaccine that's actually our best strategy.

[Paul Lucas]

That captures it pretty well. It's like drug discovery and vaccine discovery. It's a lot of trial and error and a little bit of design, but eventually you find something that actually works.

[Dr. David Butler-Jones]

Actually, the discovery of vaccination in the first place, you might remember, was for smallpox, and it was the recognition that women working as milkmaids seemed to be protected against smallpox, having had cowpox. They tried infecting people with a bit of cowpox virus and the funny thing was that those people didn't get smallpox. So it really is exploring nature for hints as to things that can make a difference.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Butler-Jones.

We'll now go into our second round, which is five minutes with questions and answers.

We'll begin with Mr. Oliphant.

[Rob Oliphant, Liberal, Don Valley West, ON]

Thank you to all of you for being here with us today. There seems to be so much intelligence at that end of the room I'm surprised it's not on a 45-degree angle.

My goal today will be to get the intelligence that's in here out into the public. You may explain this to us at great length, but it seems to me there is increasing, as opposed to decreasing, confusion in the public that is of great concern to me.

I listened to Cross Country Checkup, and on that program I heard a number of people calling yet again to raise the same issues: pregnant women at different periods in their pregnancy, people facing autoimmune disorders as well as people facing immunodeficiency disorders, people with quite different problems.

Dr. Gardam, from Ontario's public health agency, was quite successful at answering some people's questions. But as we follow the public opinion polls, actually seemingly less take-up of the vaccination is going to happen than more.

So I have concern that the information you have and are sharing with us is somehow not getting out to the public. My concern on that is what I would consider a relatively passive approach to the public campaign that we're doing. I think you've worked well. Anything in medical research involves probabilities. Anything in medical research and public health has to do with “our best guess at this time is for people to do such-and-such”, based on history and probability and medical research, etc. I'm not trying to say that research hasn't been done well enough. I am hoping it has been.

What I am concerned about is the fact that the public is less and less inclined to take this vaccination. And I want to point out two difficulties I'd like comments on.

One concern is that when it says that things are available to be distributed online or at Canada Post outlets or through a 1-800 number, that to me is a passive approach. Unlike the government's economic action plan, which is in every household, every day, all the time on the television, I am not seeing this activity.

For instance, in Britain, “Catch it, Bin it, Kill it” is a very simple approach. I didn't know I was supposed to throw out my tissue right away. I've been using this one for half an hour. I just saw this. I now know that I should throw this out. It's not a prop. It really has been used.

[The Chair, Conservative, Joy Smith]

Excuse me, Mr. Oliphant. You might have to prove that.

[Rob Oliphant, Liberal, Don Valley West, ON]

This is an active campaign. I think we're missing something about the way we need to tackle this problem.

So that would be the first question I have, which is a concern that either Health Canada or the agency is not getting this out actively, simply, and appropriately.

The second part of that is that I have a great fear that your concern with at-risk populations is actually counterproductive, because at-risk populations are at risk from someone like me, who is not at risk. If I don't get vaccinated because I think I'm not going to get really sick because I'm not at risk, then I am putting in jeopardy the health of someone else with whom I am going to come in contact.

[The Chair, Conservative, Joy Smith]

Might the doctor answer some of your questions, because you have about a minute and a half left.

[Rob Oliphant, Liberal, Don Valley West, ON]

Okay. My concern is the passive and at-risk populations.

[Dr. David Butler-Jones]

First of all, it's far from passive. The minister and I have been out several times a week now. Any newspaper you pick up.... I just picked up one of the local Metro papers, and there are two ads in there, one from Ontario and one from us. We are coordinating with the provinces. There are materials out there. Friends are telling me that they're getting tired of waking up to my voice on the radio or seeing me--and provincial medical officers and others, as well--on television.

We printed 1.2 million preparedness guides, and 885,000 have already been distributed. We're printing another two million. The fightflu.ca website is currently getting one hundred hits a second.

You will see more ads rolling out over the next while as we move into the immunization campaign. It's hard to avoid us, actually. It has not been a passive campaign in any way.

[Rob Oliphant, Liberal, Don Valley West, ON]

But the take-up is going down.

[Dr. David Butler-Jones]

No. There is a survey that suggests that it is 51%. Surveys in the summer suggested that as few as 30% were going to be immunized. It depends on the day. That survey was done before we started ramping up and before the vaccine was actually available.

On your point about those who are not at risk putting others at risk, whether it's health care workers or individuals who are healthy, the priority is to get them in early in terms of the highest risk of severe disease. But at the end of the day, we have vaccine available for every single Canadian to protect not only themselves but those around them.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll go to Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you, Madam Chair.

Last week I actually asked a question of Health Canada about information, because information is so important, especially when we're talking about confidence in the vaccine itself. People need to know. I asked them about information getting to different cultural communities in different languages. I was pleased to hear that they understood that provinces were doing that. They were translating literature into different languages. Municipalities were also doing that. I was actually more pleased to hear that Minister Aglukkaq and, I believe, Dr. Butler-Jones will be on a conference call with various ethnic media outlets later this week. Something is being arranged. I'm pleased that this is going ahead so that different languages will have the benefit of getting that information directly from the minister and you.

Dr. Griffiths, have you been working with the provinces and territories on your pandemic plan from the beginning?