Evidence of meeting #26 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was covid-19.
A recording is available from Parliament.
Liberal
President, Canadian Dental Association
—to the clinical areas where far greater separation between patients must be maintained.
Also, ensuring that the expanded range of PPE is properly worn, removed and decontaminated has significantly changed the way we work. The workflow of the office has changed to where there is absolutely no flow at all.
Some of this may resolve over time, but these challenges are putting a strain on dental practices and our ability to provide care. Of course, these challenges presuppose that one has access to the PPE to perform the necessary procedures.
From the onset of the current crisis, dentistry identified the impending shortages of PPE as a critical issue for us. We reached out through the Public Health Agency of Canada and the office of the chief dental officer of Canada to reflect that a critical shortage would hamper the ability of dental offices to provide emergency care.
We recognize the multi-dimensional challenges that led to the shortages of PPE. The current and unprecedented demands for these materials have been exacerbated by the problems in supply chains, especially in China.
In fact, early in the pandemic, when all hospitals were critically short of PPE, many dentists across the country stripped their offices of their own supplies to donate to the front-line causes in their communities, but with dental offices reopening, it's important that we emphasize that dentists are front-line providers as well. While we had initially hoped that access to PPE through our traditional sources would improve as supply chains reopened or new supply chains emerged, that has not yet happened. Some materials, such as latex gloves, have become much more difficult to acquire.
Individual dental offices are also attempting to acquire the same kinds of PPE as large government entities, most notably N95 respirators, which are essential and, in many cases, mandatory for dental care today. These government organizations, including the Government of Canada, can leverage their might to acquire mass quantities or impose guidelines on suppliers that have them prioritizing supply delivery to those entities actively on the front lines of the COVID-19 fight.
The result is a supply of PPE that remains very scarce, if not impossible to access, and at rising prices due to demand. For dentists in Canada right now, to serve our patients appropriately, we currently need one million pieces of PPE per day. This need will increase to up to four million pieces if we can reach full capacity again.
As governments and health care providers work together to find long-term solutions to sourcing and maintaining a consistent and dependable supply of PPE in Canada, dentistry needs to be at the table.
This echoes the concerns that we have stated for several years about the state of public funding for oral health care services in Canada. Most Canadians are able to access care through employer-sponsored benefit plans. Unfortunately, our public programs have been chronically underfunded across the country. Just 6% of our dental care is provided to Canadians through public programs; however, growth in the usage of publicly funded oral health care programs is particularly acute among low-income seniors, children and individuals with physical and developmental challenges. The new normal will mean even greater challenges in providing care for these individuals, if care can be provided at all.
Over the past decade, the erosion of provincial-territorial funding of these programs has created a circumstance where the needs of these vulnerable groups are no longer being adequately met. With the profound economic challenges from COVID-19 to come, many Canadians will lose access to their employer-sponsored benefits. This will place an even greater strain on these public programs.
The federal government has a clear role to play in helping to ensure that these provincial and territorial programs can appropriately address the challenges to come. Specifically, we recommend that the federal government create a specific oral health envelope of $3 billion as part of the Canada health transfer. At a time when there will be many demands on public health care dollars in Canada, we simply can’t afford to allow these programs to wait at the back of the line and hope that funds will flow through.
Finally, as we consider the challenges ahead, we clearly recognize the crisis within long-term care facilities across the country.
Several years ago, CDA asked the Department of Veterans Affairs to include basic standards of oral health care for veterans in long-term care facilities. It was our hope that these standards could have been instituted, benefiting not only the veterans in the facilities but all of those who resided in the facilities. Unfortunately, we were informed that Veterans Affairs did not have contracts with these facilities, but only contribution agreements. That left it to the provinces to ensure that appropriate care was provided.
Our suggested standards are not onerous, but are, at the very least, the minimum we believe should be provided to any senior in care. They are an oral health assessment on intake, a daily oral health plan, a yearly visit with a dentist, and a location within the facility where dentistry can be performed.
We recognize that there will be large and far-reaching discussions on how to best care for seniors in these facilities. These oral health care standards might seem minor in the current context of COVID-19, but these small steps can help to contribute to the development of a culture of care, oversight and responsibility that will be critical to setting things right for Canada's seniors.
On behalf of Dr. Burry and I, thank you very much for your attention. We'd be happy to take any questions.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We go now to Doctors Without Borders.
Dr. Nickerson, please go ahead for 10 minutes.
Dr. Jason Nickerson Humanitarian Affairs Advisor, Doctors Without Borders
Thank you, Mr. Chair, and thank you to the members of the committee for the opportunity to speak with you about the COVID-19 pandemic and the actions that Canada can take to ensure that people everywhere are able to access the medical care they need.
By way of introduction, I am the humanitarian affairs adviser for Doctors Without Borders, or Médecins Sans Frontières, MSF, based here in Ottawa. I'm also a respiratory therapist with clinical and public health experience across Canada and internationally. I have a Ph.D. in population health and have worked as a clinical scientist in Canadian hospitals and universities.
MSF is an international medical humanitarian organization that provides impartial medical assistance to people in more than 70 countries. We deliver essential health services in some of the world's most complex environments to people affected by conflict, epidemics, natural disasters, and other emergencies.
Today we are facing an unprecedented crisis, created both directly and indirectly by the COVID-19 pandemic, which has reached all of the countries where MSF works. In these places, the pandemic amplifies and deepens existing inequalities. MSF sees this on the front line every day. We are witnessing COVID-19 cases that are occurring alongside existing emergencies and creating a dangerous set of public health risks.
In the refugee camps of Cox's Bazar, Bangladesh, nearly one million Rohingya refugees live in overcrowded, unsanitary conditions that are perfect for spreading COVID-19.
In Haiti, a country where I have worked many times, our teams have opened a COVID-19 treatment centre that, within days, became full and had to double its bed capacity. We've had several patients who have died on arrival, and many more who have arrived critically ill. There are only two laboratories in the country capable of conducting COVID-19 testing, and the health system is ill-prepared for what may come.
Amidst all of this, we are all coming to grips with an uncomfortable reality, which is that our only way out of this pandemic is likely through a vaccine that does not yet exist and that needs to be globally accessible quickly to virtually every person on the planet.
Two months ago I wrote an article that warned that, given the way the global medical research and development system operates today, we face a real risk that, despite the public—that is, taxpayers—investing in the science to develop COVID-19 vaccines and medicines, these may become unaffordable, inaccessible, private-held commodities rather than globally accessible public goods. Public investment in COVID-19 science is essential, but we need to rethink our policy approaches to maximize the benefits of this investment.
Today, the pipeline of COVID-19 vaccine candidates is robust, with more than 100 candidates in pre-clinical development and 10 in human trials on eight different vaccine platforms. Many vaccine candidates are benefiting from billions of dollars of public and philanthropic funding, including more than $850 million of Canadian funding for COVID-19 diagnostics, treatments and vaccine R and D.
But the global research and development system is not designed to prioritize affordable access, especially outside of wealthy countries. Access to life-saving medicines is inequitable. This is not a problem that's unique to COVID-19, rather it is a failure of the global medical innovation system to prioritize diseases with the greatest public health threat. COVID-19 is only the latest example, and it has made it clear that we need to rethink the way we do drug and vaccine developments to prioritize patients and public health over profits.
Today, here's how the system often works. Pre-clinical discovery and work, which is what much of Canada's domestic funding is currently supporting, is done by university researchers or other publicly funded institutions. This committee has heard from some of them who are working on COVID-19. From there, promising drugs and vaccine candidates, often at a very early stage, are sold or licensed to the private sector for subsequent development, in most cases with no strings attached, no requirements that the final products be made affordable or priced fairly, and no requirements to develop them quickly or to share the data and technologies with anyone who needs them. They become private market commodities and we lose control over them, save for perhaps some small royalty payments.
Two years ago I sat before this committee during its study on federally funded health research and described how, as a result of this system, MSF teams have struggled every day for nearly 50 years to access medicines, vaccines and diagnostic tests for our patients. When they exist, they are too often inaccessible, either because of their exorbitant prices, which bear no relationship to the costs of developing or producing them, or because companies simply choose to not register them in the countries where we work because our patients do not represent a lucrative enough market.
For decades we have witnessed millions of people denied treatment for diseases such as HIV, tuberculosis and hepatitis C as a result of unaffordable patented medicines. The system cannot continue as it is, either for COVID-19 or for any other health condition.
The committee's 2018 report made nine important recommendations that should be guiding the Canadian innovation response to the COVID-19 pandemic. To my knowledge, unfortunately none of the committee's recommendations that could have helped ensure fair global access to health technologies being developed with Canadian public funding have been adopted yet.
The report included a recommendation that Canada implement common sense safeguards to ensure that licensing agreements would include specific requirements to ensure affordable global access. These provisions have already been voluntarily implemented by some Canadian universities. In their most basic sense, they would require recipients of public funds to have enforceable safeguards in place to ensure that any medicines, vaccines or other health technologies developed with Canadian public funding would be made available at fair prices in every country where they are needed, including in Canada. Essentially, it's a requirement that an investment of public funding will deliver publicly accessible and affordable health technologies—in other words, a fair return on investment for the Canadian and global public.
I'm sure we can all agree that it would be unacceptable if a vaccine to prevent COVID-19 or a medicine to treat it was developed with Canadian public funding and yet not made available or accessible to billions of people living in low- and middle-income countries, or to Canadians, for that matter. Without the right policies in place to share these technologies and the rights to them, access to them is at risk.
Now is the time to put patients' lives ahead of private profits. Here's what Canada needs to do.
First, recognize that the pandemic is global and that if we allow the race to develop and access COVID-19 vaccines, treatments and diagnostic tests to descend into nationalism, or for access to be determined by who can pay the highest price, we all lose. Not only would allowing wealthy countries to have access to essential medicines while poorer countries were going without be unconscionable, but it would also be ineffective. Until all countries and all people have access to new COVID-19 vaccines or medicines, we cannot end this pandemic.
Second, operationalize the Prime Minister's commitments to ensure that vaccines and other public health tools are produced at a scale and a cost that is accessible to all countries. Despite the current rhetoric we have seen globally around making COVID-19 vaccines and therapeutics “global public goods” or “the people's vaccine”, public funders, including in Canada, have so far failed to impose enforceable public interest conditions on recipients of public funds.
Ensuring a public return on public investment should be a guiding principle behind all Canadian funding for the development of new medicines, particularly during a pandemic. Canada should also demand transparency in all stages of the R and D that it funds, including the registration and public reporting and sharing of clinical trial data, R and D costs, manufacturing costs and product prices. If the public is investing to develop these life-saving technologies, we should be able to keep control and transparency over what we have paid to help generate.
Third, endorse open science and reject monopolies on COVID-19 technologies by sharing the technologies, data and knowledge with a global platform. Researchers have worked collaboratively and openly to share an immense amount of data, knowledge and materials to understand this virus and its weaknesses. This has consequently shortened the time frame from years to mere months to develop candidate vaccines and medicines. This openness has been an exception to the rule, and given the way the global research and development system works outside of a pandemic, there's a real risk that this innovation process will instead become closed and proprietary.
Unless significant safeguards are put into place to mandate access, affordability, transparency and knowledge sharing, we will be allowing our discoveries to be privatized and sold back to us and to people around the world at prices we don't control, because, as a rule, we don't even try to negotiate these rights. To put it in industry terms, not doing these things is simply a bad business decision. No privately run company in the world would sell a technology it invested in and knows it will need access to in the future without negotiating fair and reasonable access rights for itself, and neither should we.
We are not alone in calling for these actions. An ongoing petition on the MSF website calling for Canada to impose these common sense safeguards on the health technologies we are paying to develop has garnered more than 28,000 signatures in just over three weeks. Canadians want action to ensure that people around the world are able to access the vaccines and medicines we are investing in developing.
We need you to take responsibility for what is coming next. We are increasingly worried about countries like Bangladesh, Haiti and others, where the cumulative impact of COVID-19 on top of existing crises is producing critical humanitarian needs.
Canada needs to continue its global solidarity and support for international humanitarian assistance, but Canada also can and should demand a better deal that ensures global patient access and affordability in exchange for the use of COVID-19 technologies that are developed with Canadian public funds.
This pandemic is teaching Canadians many things. One of them ought to be that we need to rethink the way that we do drug and vaccine development so that we put patients over profits.
Thank you very much for having me today. I want to emphasize that if members of the committee have any additional questions or want clarification, they're welcome to contact me directly. Thank you.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We now go to Dr. Neilipovitz for The Ottawa Hospital.
Dr. Neilipovitz, please go ahead. You have 10 minutes.
Dr. Dave Neilipovitz Head of the Department of Critical Care, The Ottawa Hospital
Good afternoon. Thank you, Mr. Chair and members of the committee.
I am Dr. David Neilipovitz. I am an intensive care unit physician who has cared for COVID-19 patients in our intensive care unit during this pandemic. I have seen patients make miraculous recoveries from this virus. I have also cared for patients who died from this disease, including a tragic story of a husband and wife who had been married for over 50 years who both succumbed to this virus.
I'm also the lead for critical care for Ontario east. As well, I've been the head of critical care for The Ottawa Hospital for almost 10 years. As such, I was part of the groups responsible for organizing how intensive care units prepared for caring for patients during this pandemic. As such, I hope to bring the perspective of both ICU health care professionals and critical care administrators who have been challenged by this pandemic.
The COVID-19 pandemic certainly brought out the best in many health care professionals. It also brought to light some weaknesses and failings of our Canadian health care system. An obvious failing was how our long-term care facilities operate, which I suspect will be a major focus of this committee.
However, I would like to highlight another weakness, which is that of the capacity of intensive care units, particularly in how they operate and how patients enter them. Had Canada experienced a response to COVID-19 in a manner similar to New York City or Italy, the focus, I believe, of the reviews would likely have been on intensive care units and their shortcomings.
An early concern with COVID-19, as many will recall, was whether we would have enough mechanical ventilators for critical care patients. That, however, is only one important aspect of ICU care. If I don't have the space, monitors or, most importantly, the staff to care for patients, more ventilators are essentially useless.
My team at our hospital was able to increase our level 3 ICU capacity—level 3 being the highest possible level of critical care—from our existing 57 beds to over 200 beds, an increase of well over 300%. We were not alone, as many sites across Canada were able to increase their capacity by more than doubling their existing level 3 ICUs. This, however, would not have been enough if we were New York City or Italy, so how could we improve the situation and do better?
There are three strategies that I'd like this committee to consider.
First and foremost, there are no national standards or expectations for intensive care units in Canada. How ICUs are structured, how they operate, how they are staffed and even how they are equipped have no national standards or real expectations. Some ICUs that claim to be a level 3 ICU only had enough ventilators for 20% of their beds, for example. That, quite frankly, is unacceptable. Many sites lacked formally trained ICU doctors and critical care nurses, in spite of funding being available to train nurses, and more importantly, there are trained doctors who are out of work. This cannot continue. I would hope that our federal government will address this forthwith.
Second, if we had telemedicine capacity for critical care, we could certainly improve the ability of all hospitals to provide a higher level of care to all patients in Canada. I think we all know that Canada is a vast country, so the ability to provide care in all locations is challenging at best. If, however, we had a real telemedicine capacity, larger facilities like my own could help more remote locations, be they in the north or in other various isolated areas, provide better care to their ICU patients and their citizens, our Canadians, who most certainly deserve such a high level of care.
A high level of care could have been provided in these communities, and transfers of their sick patients improved or even avoided. As I'm sure you'll appreciate, sometimes, unfortunately, there's nothing that we can do for certain patients. Avoiding a transfer, however, would allow these patients to be able to pass away in their own communities, surrounded by their families and their loved ones, which is something greatly preferable to passing away alone in a facility that is remote from their home. A comprehensive solution from our federal government to improve telemedicine capacity in Canada would be crucial to improving this situation.
I have a third and final issue that would assist the capacity of intensive care units in Canada as well as improve the care provided in intensive care units.
All Canadians have a right to health care. For this there is no dispute, in my mind. The difficult and contentious issue, however, is what care do they have a right to insist upon? ICUs in New York City and Italy had to ration critical care. That is horrible and not right. However, some families insisting that their ICUs revive their loved ones and subject them to therapies, including machines and medications, when there's no reasonable chance of recovery, is equally not correct. It is not appropriate. It also greatly limits the ability of health professionals to care for other patients and puts an undue strain on our critical care resources.
Only a change initiated by our federal government can address this issue. I would respectfully ask our government and this committee to please address this issue; even though it is unsavoury, it is sorely needed.
Thank you again for giving me this opportunity to express the three ways in which the federal government could improve and increase critical care capacity in Canada: improving ICU care by creating national standards, improving telemedicine capacity for critical care, and addressing the difficult issue of what care is or is not appropriate.
I would be happy to answer or address any of these questions or other concerns. I can also be reached directly.
Thank you.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Neilipovitz.
We'll now start our questioning. Once again, we will have two rounds of questions.
Ms. Jansen, please go ahead for six minutes.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Thank you very much for these presentations.
I'd like to start with you, Dr. Nickerson. The Canadian [Technical difficulty—Editor] the company CanSino, which is working jointly with the Chinese Communist regime to develop a vaccine for COVID-19.
When the outbreak first appeared, the Chinese government silenced doctors and scientists and initially quashed information about the virus. I know I wouldn't want to take a vaccine produced by a country with such a questionable track record. If we want to get Canadians vaccinated, should we be working with a Communist regime that's shown so little transparency? Do you think Canadians would trust a vaccine that they produce?
Humanitarian Affairs Advisor, Doctors Without Borders
I don't know the particular details of the CanSino vaccine. I know that there were results published of the phase I trial, I believe, in The Lancet roughly two weeks ago.
I think the systemic global issue you're pointing to is the fact that we need more transparency and open reporting of data for all medical innovations. That's not a comment about this particular vaccine, but a comment on the broader global research and development architecture and system. We need to ensure that there is a responsibility to transparently report and share, I would say, clinical trials data—
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Would you be concerned, though, about particularly the non-transparency in working with...? I mean, we're putting I don't know how many millions of dollars into this study. Would you be concerned?
Humanitarian Affairs Advisor, Doctors Without Borders
As I say, I don't know the particularities of this vaccine. We're trying to keep track of more than a hundred vaccine candidates around the world that are being evaluated.
Again, I think what you're pointing to is the fact that data need to be openly accessible and available, regardless of who is producing it, so that the international community of experts who know about these things can independently evaluate it and assess the scientific merits of any medical product that's being evaluated.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Fantastic. Thank you.
I understand that for this particular vaccine they're using an HEK 293 cell line that they developed in 1973 from an aborted embryo. Many Canadians will have an ethical issue with this.
What are your thoughts on this? Do you believe it's wise to move forward with a cell line if we can't really reasonably expect all-Canadian participation in a vaccination program like that?
Humanitarian Affairs Advisor, Doctors Without Borders
I have the wrong Ph.D. to be commenting on cell lines and vaccine vectors. I'm a population health specialist. I'm sorry, but I really can't offer an answer to that question.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Okay.
I understand that the National Research Council has signed a contract with CanSino. We're trying to figure out whether, if we sign something like this, we can ensure that this vaccine will actually be produced and distributed in Canada. It sounds to me, from your presentation, as though we can't. We reached out last week and we couldn't get an answer from them.
I'm wondering if you have any thoughts on that. This makes me nervous.
Humanitarian Affairs Advisor, Doctors Without Borders
The global vaccine manufacturing landscape, I think, is coming into full view at the moment.
As with all these things, the devil is always in the details, and I don't know the particularities of what's in the licensing agreements or the collaboration agreement. Certainly I know there's near-global consensus that no one manufacturer is going to be in a position to mass-manufacture doses of this vaccine or of any vaccine.
I think the key point here is that the only way of ensuring sufficient quantities of vaccine or indeed of therapeutics for COVID-19 is going to be through a disseminated strategy of having multiple manufacturers in multiple countries producing quantities of these vaccines and medicines.
We're going to have to collaborate to have equitable distribution and allocation of all these medical tools. There's no logistical alternative. Everybody in the world who is working on this right now is discovering this reality.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
They all need it.
We're putting $1.1 billion, I think, into the research funding the Prime Minister has promised, and if there's no obligation for the companies receiving these Canadian funds to ensure we have access to the treatment or the vaccine, we're not gaining that much bang for our buck. That's a real concern.
It seems there's no upside for Canadians. If we're putting in all this R and D money with no guarantee, how are we going to ensure we get access?
Humanitarian Affairs Advisor, Doctors Without Borders
I think there are a few things to remember here as well.
We don't know which vaccine candidate or therapeutic is going to be effective. We're only a matter of months into the clinical trials and the development of these things. The development process is rushing ahead very quickly and, quite frankly, I think you have some of the best scientific minds in the world working on it.
As I mentioned in my presentation, the global medical research and development system is not designed around principles of global access and equitable distribution. We need a different way of developing these—
Conservative
Humanitarian Affairs Advisor, Doctors Without Borders
There are proposals on the table. Global international intellectual property pooling mechanisms are being proposed. That's effectively the idea that any intellectual property being generated would be put into a pool that allows multiple manufacturers to be able to produce it and countries to use it and so on. This is effectively a pooling of resources.
During the previous study I participated in at committee, the answer was around principle-driven open science. We should have scientists working collaboratively, sharing data, sharing knowledge, building off each other's technologies, with this knowledge and know-how being fairly disseminated and distributed to anyone who can benefit from it and use it.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Jansen.
We go now to Mr. Fisher. You have six minutes.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Thank you very much, Mr. Chair, and thank you to all our witnesses for being here today.
Dr. Nickerson, I'll stick with vaccine development just for a moment. I believe Dalhousie is having Canada's first clinical trials for a potential vaccine.
I was very taken by the idea of ensuring equitable access to a vaccine. I'm wondering if you could tell me if there are any good precedents or good practices from other jurisdictions that Canada can use as a model for ensuring equitable access.
I also appreciate the "common sense safeguards" line you used.
Humanitarian Affairs Advisor, Doctors Without Borders
Thank you.
Certainly a number of alternative models of research and development are under way around the world. There are organizations active in Canada. I'm probably going to keep coming back to the previous study because there were some very good comments that were made by the Structural Genomics Consortium. They're an open-science outfit that is doing drug development in a different way.
MSF is one of the founders of an organization called the Drugs for Neglected Diseases initiative, which is effectively a not-for-profit pharmaceutical research and development organization that has developed, I believe, seven different either new formulations of existing medicines—for example, pediatric HIV or anti-malarial combination therapies—or entirely new medicines, one example being a drug called fexinidazole, which is a treatment for human African trypanosomiasis, or sleeping sickness.
It's an organization that's guided by a core set of principles. They work with researchers, the pharmaceutical industry and the private sector, but I think the key thing behind the work they do, and indeed the work that the Canadian government should be doing at a federal level to create standards, is that the work is guided by a set of principles. Those are effectively that there's a need to ensure that the final products, whether drugs or vaccines, are affordable and accessible in an equitable manner to patients who need them, and there's a desire to develop medical tools that will be treated effectively as global public goods.
You do that by negotiating fair access provisions, with enforceable clauses and licensing agreements and contracts and so on that stipulate what is expected of any recipients downstream of the intellectual property—the data, the know-how, the substance of what's at the core of either drugs or vaccines—and that clearly stipulate how they're going to be priced, how they're going to be registered in endemic countries, how you're going to work with manufacturers to ensure global production and equitable allocation and so on.
There are actually many examples of how licences and different drugs and vaccines and so on can be developed in a different way. There are examples from the Medicines Patent Pool, from our organization, and from, as I say, DNDi, and I think the intent is not to replace the good work that's being done already in Canada but to recognize that we do live in a world where medicines are becoming increasingly unaffordable and expensive, including common sense safeguards. If we, the public, are paying to develop or discover something, we know the strings attached to it need to be fair-pricing clauses and an assurance that it's going to be made available to all patients everywhere who need access to it.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Sticking with equity and sticking with Dr. Nickerson, Patty Hajdu has said that a pandemic anywhere can quickly become a pandemic everywhere. Given that mantra, can you tell the committee why you feel it's important that we work to ensure that every country has resources to be able to respond to COVID-19?