Health Committee on Nov. 18th, 2009

[Dr. David Butler-Jones]

Yes, but they're pretty close to being finished in all three territories.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Is that because of a lack of vaccine?

[Dr. David Butler-Jones]

No, they have sufficient vaccine. It's a matter of how they rolled it out. I think they've been to all the small centres, but in the larger centres they're still hoping to finish off.

For example, in Nunavut 60% of the population has been immunized. But there's still a percentage of the population, if they're willing to come forward, in Iqaluit or wherever, who we would want to immunize. In that sense, there could still be immunization going on, but the mass campaign, the initial campaign, is essentially completed.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Are you also encouraging people who have already had the H1N1 to get the vaccine, or should they not bother?

[Dr. David Butler-Jones]

People who have confirmed H1, people who have a lab test saying they had the H1 virus, do not need the vaccine. But if you had a flu-like symptom in the spring, you can't be sure it was H1, because many other viruses were circulating at the time. In these cases it's a good idea to get the vaccine, because if you didn't have H1 last spring, you would not be protected.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

We saw some of the cases with the allergies. We don't know whether it's safe for everybody. I'm not trying to deter people from getting it; I'm just saying that there are exceptions.

[Dr. David Butler-Jones]

If you don't know if you are immune, the risk of the vaccine is tiny, less than if you were to get the flu.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

You said that there were probably underlying circumstances for the people who have had reactions. Do you know what some of those underlying circumstances are? How could people prepare for this?

[Dr. David Butler-Jones]

In respect of the vaccine, I might have been talking about the question of severe illness as opposed to reactions to the vaccine. As for allergic reactions, we see this with all medications and all vaccines. Fortunately, it tends to appear in less than one in 100,000 doses. Some people know they have an allergy to thimerosal or to one of the constituents of the vaccine. But since we're doing a mass immunization campaign, immunizing people who normally don't get a flu vaccine, there will be a percentage who may be allergic to what's in the vaccine.

The numbers are similar to what we see in seasonal flu, for which people are immunized regularly. But you won't know until it happens. That's why it's important to stay behind for 15 minutes. If you have symptoms, make sure you tell the nurse, because prompt treatment will deal with it. Clearly, if an elderly person has a severe allergic reaction, it's more difficult because of their physical condition, but generally they're all managed well.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

We're looking at headlines such as this one, which says, “Quebec drug manufacturer falling behind demand”. Based on the government's own numbers and its failure to ensure a regular supply, we now see that the vaccination program will be going well past Christmas. It will go until February, from what we can see.

What are you seeing as the difficulties that are holding the company up? We're not yet even close to the three million per week that were promised, and at one point we were down to 500,000. This week there have been two million.

[Dr. David Butler-Jones]

Part of it was the switch to the unadjuvanted vaccine. Every manufacturer around the world has had challenges in producing this vaccine as quickly as they anticipated. Canada actually has the most stable secure supply in the world at the moment. That is actually a huge advantage to Canada.

We've already immunized, as far as we can tell, as many as or more than any other population in the world as a percentage of population. We are anticipating that 75% of the population will be immunized, and we should be able to do that. Those have always been our planning assumptions. That should be done by Christmas or, at the very latest, by the end of the year.

If we find that more people wish to be immunized, that's a huge bonus, and we will continue to immunize people as long as they wish to be immunized, but we expect that anybody who wishes it will be able to be immunized by the end of the year. My hope is that it will be before Christmas.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

You're still saying before Christmas, but based on the numbers, it would appear that it's not going to happen until February.

[Dr. David Butler-Jones]

We will be seeing the numbers increase very quickly, very rapidly.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

You made a comment with regard to the reduction in the number of people seeking the vaccine. Are you attributing that at all to the chaos that's been out there?

I know that especially in the Sudbury area they've managed to buffer it, in a sense, by opening clinics that will just deal with flu symptoms. That has been great for the hospitals, but I was just trying to get some sense of it, because the health unit was still advertising this weekend that all the clinics were cancelled because they had a lack of vaccine again.

With regard to the reduction in people seeking the vaccine, is it your view that the number may increase because people are still having a hard time getting the vaccine?

[Dr. David Butler-Jones]

I think more and more people will be seeking vaccine. I think people have become quite respectful of the risk categories and are therefore waiting their turn. I've talked to many people. They come up to me and say, “I'm going to get the vaccine, but I'm going to wait until they say it's safe for me”, etc., so I think people will continue to be immunized. Short-term vaccine availability really relates to the great level of interest in people coming forward and being immunized. As more and more vaccine is available, more and more will be immunized.

I think the efficiency is very impressive. I think the lessons of the first week in terms of the challenges, not in terms of being able to move a lot larger number of people through these clinics sufficiently, have been learned. I had my own shot today, and I was very impressed. I lined up like everybody else, and I was very impressed with how quickly and efficiently they did this today in Ottawa.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Now we'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank the witnesses again for being in front of us. We've found the information you've been giving us weekly very helpful in our communications.

Dr. Butler-Jones, in terms of the number of vaccines delivered over a period of weeks, could you compare how the rollout is going this year versus the usual seasonal flu vaccine rollout? You mentioned the efficiency that we're seeing. Can you give us an idea of how it compares to the usual thing we see in Canada every year?

[Dr. David Butler-Jones]

Certainly.

While we all acknowledge some of the challenges and some of the issues with lineups in the first rush, I have been exceedingly impressed with the efforts by local public health and by provincial and territorial public health to not only learn the lessons from that but also to immunize a mass of people. In the space of three weeks and into the fourth week, we will have immunized essentially the number of people we normally immunize over a whole flu season. This is really unprecedented, and it has required efforts and professionalism at all levels, not just by public health professionals but by other people working in hospitals and the volunteers working with them.

We all would like things to go more smoothly, but in the midst of all of this, given the task they undertook, I must say I have been very impressed.

[Colin Carrie, Conservative, Oshawa, ON]

Well, I've been very impressed too, and I do commend you for your good work and the coordination with the provinces. I really would like to commend our workers on the ground. Some of them have stepped up to the plate, working the long hours to get the job done.

How is this comparing internationally, with different countries and their challenges with their rollouts? Do you have any information or data you could share with us?

[Dr. David Butler-Jones]

Well, some of it's obvious in the media. There's a lot of close observation of our American cousins, and the Mexicans and Europeans. At the moment I think we and the Swedes are probably fairly close. The Australians, fortunately, are well out of their season, so they'll be preparing for the next season to come. But certainly in terms of percentage of population immunized and going forward, not only have we already immunized as many, if not more, of the population than anywhere else, but as we go forward we actually are one of the very few countries that have the option that anybody in country could eventually be immunized.

[Colin Carrie, Conservative, Oshawa, ON]

What are you finding in the communications and feedback you're getting at the local level? You mentioned how efficient this has been. Are you seeing great cooperation, for example, in tracking the number of illnesses versus the seasonal flu? How well are we tracking the demographics? What's really important--and I know this is really important for you--is research and follow-up, what we're going to learn from this virus.

How would you compare Canada in terms of how we're getting that feedback from the front lines and the hospitals?

[Dr. David Butler-Jones]

I'll speak for Canada because of the work that we've done.

Each jurisdiction and every country organizes based on what seems to work best for them. But in terms of having the public health network, having the systems and relationships in place for sharing information, for developing plans jointly to actually be able to implement them, the chances that they will be implemented well and effectively are much greater when people actually are part of their development. So having all jurisdictions involved in this, I think, has proven its worth.

Then on the application of it, I think we've seen, as we're getting more and more experience with this virus.... You have to remember that seven or eight months ago nobody had even heard of this or anticipated that today it would be this bug and this pandemic. So there's a level of learning, and we see that translated into.... When you think, even in clinical medicine, of how quickly best practices are being adopted, how quickly people have picked up on what this is and what we need to do, adapting it; and as I've said, the work around preventing pregnant women from becoming seriously ill, with early treatment, with antivirals; the work at developing and getting systems in place for the whole range of things with this....

Anyway, it's going to be really interesting to look back at how we've applied that. But we are getting the information. Again, they're struggling to deal with what they're facing, and as soon as they can, they are sharing the best lessons and the information that we need. That's really key as we go forward, as we get a clearer and clearer picture of what this disease is and what it potentially could do.

[Colin Carrie, Conservative, Oshawa, ON]

Again, I know it's really important for you--the research on the virus, how it's behaving, the best practices. We've learned some things. You mentioned earlier the risk of infection versus the risk of mortality. You talked about seniors, that they may not get infected as often but when they do get the infection, there's a higher risk of mortality.

Is there something you could tell the Canadian public who are listening today about the latest that we've learned about this virus and what we should be looking for in our population?

[Dr. David Butler-Jones]

There are a couple of things.

One is that the basic character of the virus has not changed. The usual spectrum of illness, plus those, as Dr. Bennett was referring to earlier, who previously, as far as we could tell, were healthy who succumb or get seriously ill with this virus, has not changed. We are seeing larger numbers. As we move in through the second wave, we will see more. Even once we reach the peak, there's still the other half of it. Hopefully what we'll be able to do is truncate or reduce that because of the number of people who are immunized.

In terms of the risk of infection, again, as I said, the very young are at much greater risk of becoming ill with this disease, but their risk of mortality is less. As we're getting more experience, we're starting to see that in, for example, the 40- to 64-year age group, what we saw in the first wave is that for those who were perfectly healthy before, their risk of dying is somewhere between one in 20,000 to one in 100,000 cases, whereas if they have underlying conditions their risk of dying is more in the one per 400 to one in 2,000. Those are not necessarily severe underlying conditions. It could be somebody with well-controlled asthma.

It is something, though, that really does concern us in terms of being able to afford effective treatment and, ultimately, to immunize as many as possible in order to avoid that.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.