Health Committee on Nov. 18th, 2009

[Dr. David Butler-Jones]

Having been a local medical officer, I know that is something that we used to do. We would take these and we would adapt them to the population we have. One of the things we found was that national translations were not always useful. We got continuous complaints about things that were done one time nationally—even French—and so we had to constantly adapt them to the local dialects and languages in the communities.

I think having them out there, being able to adapt them, to the extent that we can facilitate that and share that information from those who have done it, obviously we're interested in doing that, so we're looking at that. But it seems to be a practical reality that we faced on the other end, and we ended up doing our own translations.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I guess we're still pushing for that to be an option for local public health, but if it was available nationally, particularly just “shortness of breath, rapid breathing or difficulty breathing”—that message seems to be the most important one, that those are not normal symptoms of the flu, and these people need to know that they have to seek medical attention right away.

Kirsty, do you have a question?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

First of all, thank you all for coming. We're grateful.

Dr. Butler-Jones, I want to personally thank you for your time you gave me last week.

I'm wondering if you can provide a breakdown, by province, not in terms of what's been distributed but whether we actually know how many people have been vaccinated, how many of our provinces have begun vaccinating children and teenagers, and when all provinces will be vaccinating the general population.

[Dr. David Butler-Jones]

It does vary a bit by jurisdiction. Essentially what the provinces have told us is that between seven and ten days following receipt of vaccine they're able to distribute it and immunize people. We have seen some reductions in people seeking vaccine, so as they've gotten through their higher-risk groups they've now opened it up. Ontario announced today, for example, and others as well.

It does vary by jurisdiction, and it is something that the provinces do share with us. But because it's very quickly moving, it is important that people do listen to their provincial or territorial medical officer. In the case of the territories, they're essentially done their immunization, so I could probably just say provincial.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

We'll now go to Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

Thank you to our witnesses.

I have four questions; I hope I will have enough time to put all of them to you. I will be very brief, in order for you to have the opportunity to answer them.

At the present time, we have 1.8 million doses of non-adjuvanted vaccine intended for pregnant women. Dr. Grondin was telling us last week that there was too much vaccine for this population group and therefore that other people would be able to receive the non-adjuvanted vaccine doses not needed for pregnant women.

Given the shortage that was announced approximately two weeks or more ago, the supplier having had to shift its production from the adjuvanted to the non-adjuvanted vaccine, and given also that we had ordered 200,000 doses of non-adjuvanted vaccine from Australia — which is probably sufficient to vaccinate pregnant women, of whom there are about 200,000 —, I am simply wondering why, when you saw that you had enough vaccine for pregnant women, you did not ask the supplier to concentrate production on the adjuvanted vaccine, with the option of producing non-adjuvanted doses later on if supply was lacking.

[Dr. David Butler-Jones]

Thank you.

The production in Canada of non-adjuvanted vaccine was done in October. Before that, we had approached CSL Australia because during the summer it had been impossible to obtain non-adjuvanted vaccine from the manufacturers. They were all engaged in commitments made to other countries, and the only option for Canada was to obtain the non-adjuvanted vaccine from GlaxoSmithKline. In our case, this is a major advantage that most countries do not have. CSL Australia was able to supply the vaccine because its vaccination season is over down there. We had the option of buying vaccine once the season there had passed.

The non-adjuvanted vaccine was produced in October by GSK, after which four to six weeks were required to test the formulas and the methods in order to ensure the quality of the vaccine. These decisions were made a long time ago.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

On November 7, we learned that the premiers of the provinces were asking the federal government for more timely information regarding the distribution of the vaccine.

Could you tell me how the agency responded to this important request from the provinces, that must ensure proper planning of deployment?

[Dr. David Butler-Jones]

It is not possible to ensure the total number of doses. There is the preparation, the quality assurance process, etc., but every time we have information, we relay it to the provinces. Every week, we have the list of the doses intended for each of the provinces and territories for the following week. The information is produced at the same time for the provinces and for us.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

You say that you are unable to better plan with regard to that aspect. Why is that?

[Dr. David Butler-Jones]

Everything is carried out in real time: the production of the vaccine, its distribution, the quality assurance. Everything begins at the same time. Even if there were a few months of preparation before the pandemic and if the vaccine was prepared last year, it is very important, now, that all of the doses be supplied to the provinces when they are ready. However, the number changes as soon as the preparation work is done.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Mr. Butler-Jones, in some regions, there is a shortage of vaccine, whereas in others, the vaccine has expired and must be thrown out. Could you explain how such a situation was able to come about?

[Dr. David Butler-Jones]

The provinces determine which regions will need the vaccine. These predictions are perhaps based on population numbers. From time to time, the level of interest of the population in the vaccine may vary from region to region within the province. The distribution or the prediction of the people's interest in the vaccine might be the root of the problem. Then, the provinces redistribute the vaccine to others. This vaccination campaign is voluntary. We are able to predict most of the challenges, but not all of them.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

One person died after having received the vaccine. Obviously, an investigation is underway in order to determine the exact circumstances involved. However, we know that this individual was 80 years old. From what I understand, the vaccine was to be given on a priority basis to people under the age of 65.

Could an older person have been placed on the priority list?

[Dr. David Butler-Jones]

That depends on the region and on the province. At present, the risks for the entire population have gone down and access to vaccination is better. With regard to this death, it is very important to understand the difference between the risk of infection and the mortality risk. The risk of infection is a concern for young people, whereas the mortality risk is greater for the elderly, just like in the case of the seasonal flu. These people become less often infected, but if they suffer from a chronic ailment, the risk of sickness and of death becomes much higher.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I understood, based on what you stated, that the incidence of anaphylactic shock and of death were exactly those set out in the models, or even lower. Is that the case?

[Dr. David Butler-Jones]

Generally speaking, yes, but we are at the stage where we are observing reactions and gathering statistics. More than 6 million doses are in the system and are being used to evaluate reactions. There might be others. The reactions that have however thus far been observed resemble the common reactions we see with the regular seasonal flu vaccines.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Has the Tamiflu supply issue been resolved? Will there be doses for children, adults, etc.?

[Dr. David Butler-Jones]

Yes, there is a lot of Tamiflu for the population. In the southern part of the country, pharmacists have the ability to prepare doses for small children using adult doses. In the northern part of the country, there is not always a pharmacy, because of the remoteness of certain areas. This is why we must supply these regions with doses for children.

[The Chair, Conservative, Joy Smith]

Thank you.

I'll now go to Mrs. Hughes.

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

I thank you for being here. I'm sure it's been quite hectic for you.

I want to ask about some of the things you've mentioned. Did you say that the territorial communities are done?

[Dr. David Butler-Jones]

Pretty much.

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

Is that because they managed to get all the vaccine they needed? I'm trying to get some sense of this. It's not the same story throughout the country.

[Dr. David Butler-Jones]

Remote communities are a high priority because of access to treatment. The decision was made, in cooperation with the provinces and territories, that we would provide in the first tranche sufficient vaccine for all of the territories. Most of the people in the territories live in remote communities. Our people would be able to fly into a community, do a whole community, and then move on to the next. They were provided with a small number of total doses, and they have now largely completed their programs.

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

You're saying there's still a small percentage that's not done.