Health Committee on April 30th, 2020

[Dr. Volker Gerdts]

Again, they would be developed by commercial partners who have facilities to manufacture them. They follow the same regulations as vaccine manufacturing. They have to be produced in very specific facilities, GMP facilities, that are specifically designed for this purpose, and they would be stored, I'm assuming, with these manufacturers.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

On that same subject, the Public Health Agency of Canada was developed after SARS, and as it came about, a lot of the talk was about storage of antivirals. Are you working with PHAC on developing antivirals?

[Dr. Volker Gerdts]

We have lots of collaborations with the Public Health Agency. That also includes testing of compounds that might act as antivirals.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay. That's great. Thank you very much. I appreciate that.

Dr. Fowler, I appreciate your being here. Thank you for everything you're doing.

You talked a little about clinical signs. I'm wondering if you could comment briefly, because there are a lot more clinical signs that we're hearing about. Besides the basic respiratory ones, we're now starting to hear issues of clotting, small strokes; children who might present with discoloration of their toes, etc. Can you comment on those for us, please?

[Dr. Robert Fowler]

Yes. I think that as we learn more about this, we're appreciating the spectrum of presentations that are maybe not the most common but that you notice when you see many patients. Predominantly it starts with a febrile illness of a respiratory nature, a cough. Often you just feel very unwell systemically. Respiratory illness is still the most common presentation to hospital, but we are seeing, as you've mentioned, possibly an increased rate of both venous and arterial clots. I think it's not entirely clear that this is different from baseline severe illness, but there is the suspicion that it seems to be.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Would a lot of these clots be in the lungs?

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen. Your time is up.

We'll go now to Dr. Jaczek. Please go ahead for five minutes.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you, Chair.

Thank you also to all the witnesses. I'm certainly very pleased to know that the funding the government has announced will be put to excellent use through all the ways you've described to us.

Dr. Fowler, you talked about pan-Canadian collaboration and the need for improvement. I was wondering if you could make some suggestions as to whether some specific mechanisms or structures need to be strengthened in some way. This seems to be a bit of a theme that we've heard from other witnesses through the course of this committee's deliberations. Could you elaborate on what you might see as ways to improve that pan-Canadian collaboration?

[Dr. Robert Fowler]

Sure. I'll give you two ways. One speaks a little more to the interface between public health and acute care.

One question at the beginning of the outbreak concerned capacity for care in ICUs, because we didn't know how many ventilators or how many ICU beds there were. We had done a study to try to do this brute force accounting by going hospital to hospital a few years ago, and we did come up with probably our best estimates, but there's no obvious mechanism for hospitals to talk to regions or provinces or the Public Health Agency to have this information on a contemporary basis. A mechanism to allow that to feed up at a national level would be helpful.

Second, while I think there have been very good investments from CIHR into this response, one point I wanted to make is that we often fund projects as isolated projects, clinical projects, that then have a shelf life. They tackle one question and then they're done. Not a lot of infrastructure on the ground is ready to go in the clinical research environment. For instance, there aren't research coordinators, nurses, etc., who exist longitudinally, so the start-up time is a little longer. It's hard to get that going in all parts of the country. We find ourselves trying to play catch-up.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you.

Dr. Fowler, my second question relates to the Solidarity trial. Could you describe which particular drugs are being tried—antivirals, hydroxychloroquine—or what they might be?

You made reference to the fact that some trials have been done, although not in very large numbers, and they were discontinued too soon. How is the Solidarity trial going to be different? Maybe you could elaborate on the numbers you're looking at for each of the medications that will be tried. Will the assignment of the particular medication to the patient be randomized? Will there be a placebo—in other words, no treatment? Could you give us a description of how that is all going to work?

[Dr. Robert Fowler]

This trial is one that's happening in over a hundred countries around the world, and Canada was one of the early folks to sign on to it. In fact, we helped design a lot of it.

It's a randomized trial, so patients are assessed for eligibility. Then they get one of the treatment arms or the standard of care.

The current treatment arms in Canada include one medication called Kaletra, or Lopinavir/ritonavir, which is typically used for HIV, and very successfully so. It was evaluated in a relatively small trial in China without the ability to be confident in its effect, and it therefore needs to be tested in a large number of people. There are a number of trials happening that will have larger numbers, and this is one of those. The numbers of randomized patients are in the many thousands, as opposed to many hundreds.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you very much.

Do I have time left?

[The Chair, Liberal, Ron McKinnon]

You have one minute.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

My final question is for Dr. Annan.

You've described Genome Canada's work in looking at viral mutations and also at human genetics to see if there are particular tendencies to be susceptible to various viral mutations, etc. You're obviously doing this for COVID-19. Have you done similar work for other viruses, and has it led to some sort of clinical outcome that was successful?

[Dr. Rob Annan]

Perhaps I'll ask my colleague, Dr. Bell, to answer that. She has extensive experience with clinical research and the medical application of work—

[The Chair, Liberal, Ron McKinnon]

Dr. Annan, move your microphone, please.

[Dr. Rob Annan]

Sorry. I was just passing it to Dr. Bell, who is better positioned than I am to answer the question.

[Dr. Cindy Bell, Executive Vice-President, Corporate Development, Genome Canada]

We really have not done any significant research on virals before. We did some work in the past with VIDO in our early years in developing vaccines etc., but nothing that would compare to what is needed in this particular case.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Jaczek.

We go now to Mr. Webber. Please go ahead for five minutes.

[Len Webber, Conservative, Calgary Confederation, AB]

My first line of questioning will go toward VIDO-InterVac and Dr. Paul Hodgson.

In his presentation. Dr. Gerdts talked about the development of the 10 vaccines that your organization has developed so far, one being for pigs. It took 18 months to get that vaccine, but it is currently out there and being used.

I want to talk a bit more about the mechanics of who owns the rights to these vaccines and who will have access. I know this was asked earlier by a few others, but I would like some further clarification.

If a company like yours develops a vaccine, is this a licence to print money, or are there regulations about how it can be sold and how it can be distributed? Are there any international agreements or is there a framework in place for the sharing and the distribution of these future vaccines? Will there be a mad rush from all nations, or is there an orderly distribution process to follow? There are a number of questions here in anticipation of a vaccine being developed.

If a company such as yours develops this vaccine here in Canada, is it up to the—

[The Chair, Liberal, Ron McKinnon]

Len, I think you cut out there.

Mr. Webber?

[Len Webber, Conservative, Calgary Confederation, AB]

Okay, I don't know what happened there. I froze. I don't know why, but I'm back.

[The Chair, Liberal, Ron McKinnon]

Okay.

I think the actual question at the end of your preamble was missed, so please ask it and—

[Len Webber, Conservative, Calgary Confederation, AB]

Okay.

A company such as yours at VIDO, Dr. Hodgson, hopefully will soon develop a vaccine here in Canada. Is it up to you to determine how it will be distributed, or is it the federal government? Do they have a say on how this would be distributed out there worldwide? Maybe you could give us some indication of how it was with the 10 vaccines that you developed in the past.

[Dr. Paul Hodgson]

Thank you very much for the question.

There's actually a very long and complex answer. The previous vaccines we've developed have been for animals, which is a much simpler regulatory process. The human vaccines generally take 10 years to develop, and the estimates now suggest up to a billion dollars. For clarity, we are not a company. We're a part of the University of Saskatchewan, and even with the contributions from the federal government, we do not have the pocketbooks to bring this all the way up to a full regulatory licence.

That being said, one of the other things that's come up is that we don't know the market demand for this, but given the current population of the world, there is no single vaccine manufacturer that would be able to actually produce enough vaccine to satisfy world demand. I think what we're seeing now, even on the World Health Organization calls, is a fairly open dialogue around how knowledge translation will happen around the world if there is a technology that seems to be the frontrunner.

One of the things that you've potentially heard Dr. Gerdts say on CBC and on other news outlets is that it's a priority for us to ensure that Canada, if it's our technology, has the vaccine. Again, we do not have the capacity to bring this all the way through, but when we work with partners, we never give up ownership of it. We license the technology to be able to have a company produce that. We have clauses in there to ensure that they meet milestones and that the development proceeds as aggressively as possible. There is also usually a clause in there that Canada will get some sort of preferential treatment, either preferential pricing or preferential distribution. It is always a concern of ours as we try to move these technologies forward to licensed products.