Health Committee on June 10th, 2020

[Dr. Jason Nickerson]

As I say, I work for an organization that's operational in some of the most complex public health emergencies in the world, in more than 70 countries. I've worked in many different places that have very weak health infrastructure, where the ability to provide the kind of care that Dr. Neilipovitz was describing almost certainly does not exist or exists in very limited capacities.

In those kinds of places, a vaccine or a treatment that may prevent people with a mild disease from progressing to a more severe form of the disease is absolutely essential to potentially averting a public health catastrophe being overlapped on an existing emergency. I think it's as simple as that. We need these public health tools to be made available to everyone everywhere because, quite frankly, it's ethically and morally the right thing to do, but also just pragmatically, this is an infectious disease that's communicable. We are in a global pandemic and we've seen how quickly it can spread from one place to another.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Canada has done a pretty great job. As borders get ready to reopen, what are your biggest concerns about places that have yet to do a great job, countries that have yet to flatten that curve?

[Dr. Jason Nickerson]

We're still trying to assess the impact of the global pandemic on a day-to-day basis. There are cases now in virtually every country where MSF works. Interestingly, a lot of the countries where we work have public health professionals who are experienced in responding to disease epidemics and working in different types of emergencies. There is, in a sense, some capacity that exists on the ground that is actually quite experienced in doing things like contact tracing and so on. We are very much still assessing and responding to needs as we see them.

As I mentioned, in places like Haiti.... We put out a statement or a press release last week describing the realities that we're seeing on the ground, which is that as moderate to severe cases start to occur, the potential for health systems to be overwhelmed or struggling to cope is patently evident.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Fisher.

We'll go now to Monsieur Thériault.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I'm going to address Mr. Nickerson, but I'm going to let him catch his breath.

Mr. Nickerson, Doctors Without Borders has considerable international field experience with pandemic issues. Doctors Without Borders has always believed in mitigation measures. You have considered border or school closures and quarantine. Even if that didn't stop the pandemic, you said it would slow it down.

The WHO has given conflicting advice in this regard. On March 14, it was said that border closures and quarantine were not a solution. Three days later, the director of the WHO European region said that this had the advantage of slowing down the pandemic. On Monday of this week, Maria Van Kerkhove, the technical lead of the pandemic management unit at the WHO, said that transmission of the virus by an asymptomatic person seemed to be very rare, which prompted a reaction from the community. Professor Liam Smeeth explained that asymptomatic infections could be in the range of 30%-50%. The best studies suggest that almost half of the cases were infected by asymptomatic or presymptomatic people.

My question is quite simple. What do you think of the effectiveness or the consistency and conflicting opinions of the WHO in the management of this pandemic?

[Dr. Jason Nickerson]

It's a big question.

We are a medical care organization that employs physicians, nurses and public health specialists. These are people who are incredibly adept at responding to public health crises as they occur in the field. We're no stranger to public health emergencies and outbreaks.

I can tell you what our response has been in terms of trying to evaluate and keep track of the emerging evidence. We have teams of medical processionals with expertise in this area who are putting together guidelines and trying to keep track of the evolving recommendations that are coming out. We are all learning as we go through this. I think there is great value in having coordinated voices and having clear guidance from public health officials around the world.

I think that my key message in all of this is simply to say that the evidence is emerging. It's evolving, and we're all doing our best, trying to read articles in The Lancet and other medical journals as they emerge and appear.

[Luc Thériault, Bloc, Montcalm, QC]

Your answer is quite cautious, despite your young age. However, do you believe that the main actor, the WHO, should have less contradictory positions and less hesitant guidelines, which would allow more progress to be made? Are you concerned about that?

What is your opinion on the controversy over contamination by asymptomatic or presymptomatic people?

[Dr. Jason Nickerson]

I think we're all learning a lot about public health messaging as we work through this pandemic.

To a degree I empathize with people who are in a position of having to communicate rapidly emerging evidence and give an assessment of, quite frankly, imperfect evidence, because we're all learning effectively in the middle of a pandemic.

I agree with the point that clear risk communication and public health guidance are absolutely essential, but as I say, we're all learning in the middle of an unprecedented global public health emergency, and it's a challenge.

[The Chair, Liberal, Ron McKinnon]

Thank you.

I'm sorry, Mr. Thériault; you have one minute left.

[Luc Thériault, Bloc, Montcalm, QC]

Studies conducted by researchers at the University of Montreal Hospital Research Centre provided interesting data on antibodies generated by COVID-19.

A study showed that six out of ten infected people produced neutralizing antibodies only two weeks after the onset of disease symptoms, but the neutralization lasted six weeks. This suggests that the vaccine implementation strategy, if available, would include a booster vaccine.

Since you are concerned about international accessibility and equity, what is your opinion on this level of difficulty added to the solution of vaccinating and immunizing the whole planet?

[Dr. Jason Nickerson]

Yes, absolutely. One of the roles of international organizations is, in fact, to develop what are called target product profiles. What is the ideal profile of the vaccine that would be deployed around the world? In designing the ideal set of parameters that we would want a Canadian vaccine to have, it's absolutely essential that we and any other public health organization take that into consideration.

Indeed, at the table are representatives of countries that are going to potentially be particularly disproportionately impacted by this.

We know from other vaccines that the way in which they're developed is important. Whether it's injectable or administered with a dropper, at what temperature it needs to be stored, how long it can be out of the fridge, how many doses are in a vial and all of these things have to be included in the design and the development of vaccines at the early stage. That is absolutely essential for making sure we have a vaccine that is well adapted for global use so that it has the maximum potential impact and efficacy.

What you're describing, I would say, is a good example of that.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for being here.

Dr. Nickerson, beginning with you, are there any international safeguards in place currently to ensure that COVID-19 treatment and vaccine supplies are distributed based on need rather than on national wealth or political clout?

[Dr. Jason Nickerson]

Thanks for the question.

As I mentioned in my statement, the short answer is that we are seeing these statements being made by a variety of different heads of state and other actors that seem to be committing to these sorts of principles, let's say, of global public goods, of people's vaccines and of ensuring equitable access and so on. That is certainly a positive step.

As I mentioned, the global research and development system and global pharmaceutical system is not developed around the use of these principles of equitable access. The system is designed in such a way as to effectively generate profits and to maximize those. We need enforceable language to be included in funding commitments and included in licencing agreements and, frankly, to be imposed to achieve those objectives.

[Don Davies, NDP, Vancouver Kingsway, BC]

Let me move to a proposal for that. I understand that the Government of Costa Rica has proposed that the World Health Organization set up a global pooling mechanism of intellectual property rights, research and data for all COVID-19-related technologies. They say that this would accelerate open innovation and support the scale-up in production of necessary COVID-19 technologies and other things. Has the Government of Canada made a public statement of support for that initiative?

[Dr. Jason Nickerson]

To the best of my knowledge, no. I did check the WHO website earlier today, and I did not see Canada listed there. I may have missed it, but to my knowledge, no.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Beyond just political commitments, you talked about the importance of safeguards. Has the Canadian federal government implemented any safeguards to ensure that COVID-19 vaccines, diagnostics and therapeutics developed with public funding are affordable and accessible to the people and health systems that need them?

[Dr. Jason Nickerson]

Again, to the best of my knowledge, the answer is no. I've been following the work of the committee for the past while, and I know that this question was posed at one point. I believe the answer was that there was no language to that effect in at least one of the funding agreements that was made.

As I mentioned earlier, this is not typically the way that funding is rolled out in Canada. There is no requirement on recipients of public funds to have some sort of global access licensing or fair access policy in place at the institutional level.

Often, the system works the way that I described it. We have researchers who receive public funding, and university labs and other places do the discovery work, and then promising candidates are sold to the private sector with effectively no strings attached. That should change.

[Don Davies, NDP, Vancouver Kingsway, BC]

In March, you wrote an op-ed. I'll quote from it. You said:

Canada may not even have to depend on commercial partners to bring medical innovation from the lab bench to the patient's bedside. The experience of the Ebola vaccine's development shows that public sector researchers did much of the heavy lifting in the development and even manufacturing of early batches of the vaccine. We have experts in clinical trials in our hospitals, universities and vaccine research groups who are more than capable of doing the necessary clinical trials to develop and deliver new health technologies quickly and affordably.

In your view, would a public drug and vaccine manufacturer of the kind Canada used to have with Connaught Labs help ensure affordability and the development of medications and vaccines that are developed, obviously, through public funding?

[Dr. Jason Nickerson]

I've said this a few times now, but the pace at which the science is unfurling in the COVID-19 vaccine and therapeutics development is absolutely unprecedented. When I wrote that op-ed, the CanSino collaboration agreement didn't exist yet.

I think that point is emphasized by what Mr. Fisher mentioned. The clinical trials work is going to be done by researchers at Dalhousie University, who have expertise in doing these kinds of clinical trials. There is expertise in doing at least some kinds of phase I through phase III clinical trials that exists in universities and other research institutes and in other places. There are models of innovation that do not have to rely solely on the sale of early-stage promising drug and vaccine candidates to the private sector. There are different ways of doing this.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

To the Canadian Dental Association, thanks for being here.

We know the work that the CDA has done. Somewhere between 33% and 35% of Canadians have no dental coverage at all at any time. Now, as you pointed out, we know about three million Canadians have lost their employment as a result of COVID-19 and with that, any dental coverage they may have had through their employer.

Do you believe it's time to reevaluate Canada's method of delivering dental care so we can ensure that all Canadians get access to essential oral health?

[Dr. Jim Armstrong]

Would you like me or Dr. Burry, the public health expert, to answer?

[Don Davies, NDP, Vancouver Kingsway, BC]

Whichever you prefer.

[Dr. Jim Armstrong]

I'll go first.

I do think it's time. That's why we made our proposal. I think there are a lot of different ways we can look at it. As Dr. Nickerson said, we're in the midst of trying to figure out how our systems.... There's so much that we're learning about the shortcomings of the systems through this COVID crisis.

There are interesting aspects to the Affordable Care Act in the U.S. There are European models. We've done a lot of research over the last 18 months on different types of models to care for those patients. More Canadians are going to lose their oral health coverage. They're going to need access. We absolutely agree.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings round one to a close. We start round two with Dr. Kitchen.

Dr. Kitchen, please go ahead for five minutes.