Health Committee on Oct. 26th, 2009

[Elwyn Griffiths]

There's a lot in there, but very briefly on autoimmune disease--Guillain-Barré syndrome, for example, could be an autoimmune disease--these are so rare you'd really have to look at the big picture here. You would not see these until you actually roll out into millions.

As Dr. Butler-Jones explained earlier on, I think it's one in a million with the seasonal flu vaccine, if that is really the link. We don't know. Many of these are brought up as potential theoretical risks, which are sometimes very difficult to prove. They're rare, extremely rare, so the issue here is that you have to balance the risk of a real threat to health and to the lives of individuals against this theoretical risk.

I didn't quite follow your point about Australia, but I can simply say that whatever is happening in Australia...we're in very close contact with the regulator in Australia, because we have these routine teleconferences, not only with them but with the U.S. and with Europe, and we discuss all these issues that come up, so we will know if anything comes up.

[Patrick Brown, Conservative, Barrie, ON]

Aren't reports suggesting that the flu season in Australia was not as bad as it was here?

[Elwyn Griffiths]

Oh sorry, the H1N1. Yes, it was fairly mild, but that was their first wave. They expect the second wave in spring for us--our spring, essentially.

[Patrick Brown, Conservative, Barrie, ON]

Mr. Lucas?

[The Chair, Conservative, Joy Smith]

Would you like to comment?

[Paul Lucas]

On the production side, all I can say is the strategy has worked in having a sole supplier domestically located, in this pandemic anyway. We are on track. We are on schedule in terms of producing the vaccine. We are one of the only countries in the world that will basically have enough vaccine to vaccinate its whole population with one dose by Christmas. We are in a strong position in Canada as a result of that strategy.

[Elwyn Griffiths]

Could I add a point there? I think you have to remember we're not making Aspirin or Coca-Cola, or something, when you're making vaccine. When you make a vaccine, there are biologics that are very difficult to make. You can have policy based on the best science that's available, but then biology often confounds issues.

Let's take the issue of supply--and this is where I was going to comment here. I'm sure you're all aware that the U.S. is now having difficulty with the supply of vaccines, although I think they have four or five manufacturers supplying. I think with all the best will in the world, the manufacturers predicted that they would be supplying 130 million doses to the U.S., or whatever. But the reality was....

Let me put it this way. We think we're dealing with a flu virus, as if it's sort of the same thing, you know. They change slightly every year. Somebody mentioned earlier on that there are very subtle changes in these viruses, and how they behave is very different. This particular virus, it turns out, grows very, very poorly. That wasn't predicted when they started to make these vaccines, and that really has caused a huge problem with the supply.

So I think you have to balance the best science you have to make the policy, but on top of that, you have to bear in mind that we're dealing with biology here as well.

[Patrick Brown, Conservative, Barrie, ON]

On domestic production, Mr. Van Exan.

[Rob Van Exan]

Yes, only a comment.

In fact, on October 22 at the ACIP meeting in the U.S., the U.S. experts actually came out and said, “Thank God we have multiple suppliers.” There are five suppliers in the U.S., and they were able to get their first deliveries of vaccines starting on September 29. This really speaks to the idea of having multiple suppliers. If one is a little slower, another one will come.

In terms of domestic supply, the benefit of having two suppliers, one domestic and one not domestic, is that you don't have all your eggs in one basket. Pardon the pun, but if you were to have flocks in Canada infected, you would still have flocks in some other part of the world--

[The Chair, Conservative, Joy Smith]

Excuse me, Mr. Van Exan, we're running out of time. Thank you for your comments.

We have about 30 seconds or so left, and I'm wondering if I can ask a question. Okay.

I don't know if you can answer this, Dr. Griffiths, or if I need to ask Public Health. For people who have compromised immune systems because they have HIV, cancer, bone marrow transplants, or rheumatoid arthritis, what kind of vaccine is recommended? Is it the one with the adjuvant in it? What is the recommended dose for someone like that?

[Elwyn Griffiths]

I think Dr. Butler-Jones should be speaking to this.

[The Chair, Conservative, Joy Smith]

I know.

[Elwyn Griffiths]

The recommendation is to use the adjuvanted vaccine because they usually respond very poorly. But those data are not available yet. We are moving forward here, but there are still these special groups that we need to study. Do we need one or two doses of the vaccine? It's an ongoing dilemma on how to deal with those people, but I think the recommendation is to use two doses of the adjuvanted vaccine.

[The Chair, Conservative, Joy Smith]

Okay. When Dr. Butler-Jones returns, we'll probably ask him.

I want to thank the committee very much for coming.

I want to thank our guests especially for being here today. Your comments were very insightful.

As you know, the Subcommittee on Neurological Disease will be meeting on Wednesday.

The committee is adjourned.