Evidence of meeting #31 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was vaccine.
A recording is available from Parliament.
Chief Commercial Officer and Executive Vice-President, Apotex, Canadian Generic Pharmaceutical Association
I think that's part of our blueprint. If you take that product, we've talked about retrofitting our facilities, working with Health Canada, working with the Canadian government, working with Ontario. We're prepared to do what we need to do to support Canadians. Right now—
Liberal
The Chair Liberal Ron McKinnon
Thank you. I'm sorry; I have to cut you off.
Mr. Fisher, please go ahead for five minutes.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Thank you very much, Mr. Chair.
Thank you to all of our amazing witnesses who are here today to provide this level of expertise.
Not because he's in Nova Scotia and is a three-decade Nova Scotian, I want to stick with Dr. Halperin, if I could.
Dr. Halperin, the Canadian Centre for Vaccinology is leading the first human clinical trials in Canada for a COVID-19 vaccine. Can you describe the technology used and how it differs from other potential vaccines?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
Sure. In terms of the trial we're doing with CanSino, which may or may not be the first, depending on when the vaccine arrives, that vaccine is, as I'd mentioned before, an adenovirus 5, which is a normal human respiratory pathogen that causes an upper respiratory infection, that has been modified to express the spike protein to make the spike protein of the SARS-CoV-2 virus. Therefore, when the host sees that platform, it makes antibodies against the spike protein. Hopefully, that would then protect somebody who comes in contact with it. The adenovirus 5 has been modified so that it's a non-replicating virus, which means it doesn't replicate in the host.
So that's the platform. That's how it works.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Where are you right now with regard to safety and effectiveness? Are you able to provide any of your early results?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
We haven't yet started the trial with that vaccine here in Canada. We're hoping it will start in the very near future.
That vaccine has undergone phase one and phase two studies in China. The phase one studies were quite successful and were published in The Lancet Infectious Diseases. Phase two studies have now been completed. My understanding is that those should be published within the next week or two in the same journal, also showing safety and good immunogenicity. With regard to the effectiveness or the efficacy of those vaccines, we will need to await the phase three studies that will be taking place.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
When the clinical trials roll out across Canada, will that be just in Nova Scotia or will you be going to other provinces? Will you be utilizing or testing vulnerable populations in these clinical trials?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
We'll be using all of our CIRN clinical trial sites as these trials roll out. Medicago's going to be using sites across Canada with its vaccine. We are talking with at least four others besides CanSino that will be rolling out, hopefully, over the next several months as they become available and ready for phase one studies.
Of our 10 clinical trial sites, five of them have a lot of experience in phase one studies, but most of these trials are being designed as phase one and two studies. The phase two portions will be done in several of those other cities. It will be a cross-Canada effort to undertake these trials.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
That's excellent.
When we talk about immunity for folks who have had COVID-19, I don't know if the science is really there yet, but we've heard that it could be just two to three months. How does something like that impact an outcome of a vaccine?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
It's very important. We don't have full information about a natural immunity after a natural infection with SARS-CoV-2. That's a very important priority for the immunity task force. Canada's immunity task force is undertaking seroepidemiology studies on patients, just on the general population, to see how many have become infected without any symptoms and without being diagnosed, as well as to follow patients who've recovered from SARS-CoV-2, to see how long they maintain their antibodies.
Again, we're not 100% sure yet, and research is still under way about what is the most important factor in the immune system. We talk about an antibody, but there's also cellular immunity, which in viruses is very important. How long the protection lasts is something we need to know. That's with every vaccine, not just SARS-CoV-2 vaccines, which is why for the measles vaccine, for example, you get one dose as a child and you're protected for life, whereas with the influenza virus, it lasts for, perhaps, one season. We know that for an influenza virus, even by the second half of a season immunity is dropping off. Where SARS-CoV-2 will fit in, time will tell. If it's not of very long duration, that may just mean we will need to have second boosters, which again becomes a question of how many doses we are going to need over time.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Fisher.
Mr. Desilets, you have the floor for two and a half minutes.
Bloc
Luc Desilets Bloc Rivière-des-Mille-Îles, QC
Thank you, Mr. Chair.
My question is for Ms. Fralick or for Dr. Neame.
Professor Kelly Grindrod, an expert in the School of Pharmacy at the University of Waterloo, is conducting research to verify and validate the supply of medications in Canada. She considers that the country is already in the grips of one of the worst shortages of medications in our modern history. She claims that, before the arrival of COVID-19, there was already a shortage of more than 1,900 of the 7,000 or so prescription medications in Quebec. That is about 25%.
Ms. Grindrod insists that, in Canada, the entire system lacks transparency. She says that planning is already difficult in normal times, that information is vague and that it is even difficult to find out where the medications are made and where they end up. In her opinion, it is practically impossible to do that kind of monitoring.
Could you please tell us whether you share that opinion and what you think about it?
President, Innovative Medicines Canada
I will start by acknowledging, as several have, Mr. Keon in particular, that the drug industry is global. Whether we're referring to generic or patented drugs, it is a global industry with inputs from around the world. There are multiple ways in which the supply, the supply chain, the flow of drugs can be affected. That's a starting point.
The drug companies—all of them—are required by law, and they do follow this, to report any drug shortages on a Government of Canada website, drugshortagescanada.ca. We have been monitoring that website on a daily basis, just to see where the shortages might be. I'm not quite sure how to respond to a charge of lack of transparency, because this is followed through.
As I said earlier, with our companies we have been extremely vigilant in monitoring any drug shortages, not only from the website itself, but also through talking with our companies on a regular basis, sometimes daily. While we recognize the need to continue to be vigilant, we have not found ourselves in a position where we've been unable to supply the drugs that have been needed.
That being said, I think there's a slightly different story on the generic side. You may wish to also throw your question over to Mr. Keon.
President, Canadian Generic Pharmaceutical Association
Well, I'm happy to answer again. Just quickly, we in the generic pharmaceutical industry have worked throughout this very closely with distributors and pharmacies in Canada, and with our own member companies. Our own member companies are, as was said, required to report all shortages wherever there has been a shortage.
There was a concern at one time about the increased use of sedatives and muscle relaxants, etc., in intensive care units treating COVID patients. Our companies were able to repurpose to increase production and increase the products coming into Canada. We worked with Health Canada. We worked with the group purchasing organizations in the provinces. We ensured that products were available in all cases throughout the pandemic.
As we said earlier in our presentation, we are quite proud of the fact that a lack of medicines, or shortages of medicines, never became a major problem for Canada, even at the worst of the pandemic shock that we faced.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Desilets.
We go now to Mr. Davies. Please go ahead for two and a half minutes.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Dr. Halperin, according to a May 19 news release from Dalhousie University, the National Research Council will work with manufacturers so the vaccine can be produced and distributed here at home—or, hopefully, a vaccine, if it proves to be successful. Are you confident that Canada has sufficient domestic manufacturing capacity to produce a sufficient supply of vaccines for all Canadians, particularly if we have to have booster shots and extensive revaccinations?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
Manufacturing capacity in Canada is one of the biggest concerns, and that was highlighted very early on in the pandemic, and before. Part of the funds that the government announced early on in the pandemic were to be provided to the National Research Council, NRC, to upgrade its facility in Montreal. This will permit it to do what's called a GMP, or a good manufacturing process, when manufacturing the vaccine. Based on that, my understanding is that it will be able to supply the needs with CanSino's vaccine.
Now obviously that's not the only vaccine that's being developed. My understanding is that each manufacturer, when it's doing studies and getting supported, in order to get support from the Canadian government, has to demonstrate what its plan is for manufacturing. Whether they are proposed vaccines from Medicago or VIDO-InterVac, all have to look at the manufacturing capacity.
I think manufacturing capacity will be an issue. Obviously, the larger multinationals, such as Sanofi Pasteur, which Dr. Neame mentioned, certainly have the manufacturing capacity.
Country Medical Lead, Sanofi Canada, Innovative Medicines Canada
If I could add as well, and I apologize for jumping in on Dr. Halperin's question, but the fact is that this is where collaboration occurs. To produce 60 million doses of infant vaccines each year on the Toronto site, this is where we have to sit down and talk. We could potentially retrofit something at the Toronto site, which could help out. It's all about Canadians and getting vaccines for Canadians.
NDP
Don Davies NDP Vancouver Kingsway, BC
To each of you doctors, then, would you recommend that the federal government develop a national plan in order to ensure that we have domestic manufacturing capacity for any vaccine that, hopefully, will be developed for Canadians?
Professor of Pediatrics and Microbiology and Immunology, Dalhousie University, and Director, Canadian Center for Vaccinology
Absolutely. As I mentioned in my initial comments, that's part of it. We all know what the steps are in order to get vaccines to individuals. Hopefully, all of that is being worked on simultaneously. There is now a vaccine task group that's been tasked to oversee the process, and manufacturing is clearly on its radar.
Country Medical Lead, Sanofi Canada, Innovative Medicines Canada
Just remember there are actually companies like GlaxoSmithKline. GlaxoSmithKline has a great pandemic plan. The only problem is it's for influenza. We didn't expect it for COVID. There needs to be some expansion on the infectious diseases that we're covering in pandemic plans.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies. That brings round two to a close.
I'd like to thank all the witnesses for sharing your time with us today, and for your expertise. This is most helpful to our study.
We will suspend, and bring in the next panel.
Liberal
The Chair Liberal Ron McKinnon
The meeting has resumed.
I'd like to welcome back everyone to meeting number 31 of the House of Commons Standing Committee on Health. Pursuant to the order of reference of May 26, 2020, we are continuing a briefing on the Canadian response to the outbreak of the coronavirus.
I'd like to make a few comments for the benefit of the new witnesses. Before speaking, please wait until I recognize you by name, except during questioning. I'll ask the questioners to indicate whom they wish to respond to the question. When you're ready to speak, you can click on the microphone icon to activate your mike. I remind you that all comments should be addressed through the chair.
Interpretation in this video conference will work very much like in a regular committee meeting. You have a choice, at the bottom of your screen, of floor, English or French. As you are speaking, if you plan to alternate from one language to the other, you will need to switch the interpretation channel so it aligns with the language you are speaking. You may want to allow for a short pause when switching languages.
When you're not speaking, your mike should be on mute.
I'd like now to welcome our second panel of witnesses. Appearing as an individual we have Mario Possamai, who was senior advisor, Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome, 2003-07; for Mapsted, we have Paramvir Nagpal, founder and chief executive officer; for Medtronic Canada, we have Patrick Hupé, senior director, health systems strategies.
I will ask the panellists to make their statements. Each group will have up to 10 minutes.
We'll start with Mr. Possamai. Please go ahead.
Mario Possamai Senior Advisor, Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome (SARS), 2003-2007, As an Individual
Good afternoon, Mr. Chair, and members of the committee. Thank you for the opportunity to brief you on how COVID-19 has revealed that the system to protect Canadian health workers during a public health emergency is broken, and must be fixed urgently before the expected second pandemic wave.
From the start of the outbreak, the Public Health Agency of Canada has said that droplet precautions, including surgical masks, are sufficient protection for our health care workers, because COVID-19 could not spread through the air, and only spreads through large droplets.
In those early days, Canadian experts who supported the agency's position said that if COVID-19 was airborne we would see outbreaks in places adhering to droplet prevention. One expert said that if this was airborne, all those health care workers would be getting sick.
Here's what's happened since. Nationally, Canadian health care workers comprise nearly one in five of all COVID-19 infections in Canada. That is almost three times the global average as reported by the International Council of Nurses.
It is also approximately four times the rate in China where there was a requirement for the use of airborne precautions, including N95s, in late January. Most health work infections in China occurred before these higher precautions were implemented. This troubling situation is why I have been retained by the Canadian Federation of Nurses Unions to use the lens of the SARS commission to investigate why so many Canadian health care workers are being infected. While the investigation is at an early stage, I would like to share some preliminary findings and recommendations.
The first preliminary finding is regarding the precautionary principle, and the question of airborne transmission. When your committee met on April 7, dedicated Canadian experts, with the best of intentions, said that COVID-19 only spreads through large droplets and contaminated surfaces, and that surgical masks were sufficient protection. N95s, they said, were only needed for high-risk procedures. Since then, the science has evolved. The researchers in Hong Kong, who first identified SARS airborne transmissibility in 2004, have recently published a peer-reviewed article suggesting that large droplets are a negligible transmission route compared to airborne.
The CDC in the U.S. is now suggesting that infected surfaces may only play a minor role in COVID-19 transmission, and most importantly, an open letter published today by 239 scientists from 32 countries, the WHO and public health agencies, states that studies have demonstrated beyond any reasonable doubt that the viruses are released during exhalation, talking, and coughing in microdroplets, small enough to remain in the air, and impose a risk of exposure at distances beyond one to two metres.
Time will tell who is right and who is wrong in this debate though I believe the scales are increasingly tipping toward the growing evidence of airborne transmission. This is precisely the kind of situation where the precautionary principle and the findings of the SARS commission should be invoked. When there's uncertainty about a new pathogen, it calls for erring on the side of safety, and protecting health workers with the higher protections of airborne precautions, including N95s or higher, until the science is clarified. This is what China has done so successfully, and that is why the WHO has concluded that the transmission of COVID-19 among health workers and in health care settings is not a factor in China.
Keep in mind that it was not until a year after SARS that the best evidence of its airborne transmissibility under certain conditions was published. Justice Archie Campbell, who led the SARS commission, found that this was strong validation of the prudence of taking a precautionary approach until the science was settled.
Having regard to growing evidence of airborne transmission and with news that domestic production of N95s is coming on stream, I recommend that the Public Health Agency of Canada invoke the precautionary principle and require airborne precautions, including fit-tested N95s for all health care workers in all health care settings with suspected and confirmed COVID-19 cases. I also recommend that the federal legislation be amended to require the agency to take a precautionary approach to all worker safety guidance.
The second preliminary finding is with regards to our severe shortage of N95 respirators. Even though the SARS commission recommended stockpiling this vital piece of equipment, the federal health minister and the chief medical officer of health have claimed stockpiling was a provincial responsibility. I respectfully disagree. Ottawa destroyed two million N95s last year. It should have replaced them and purchased more, as the Prime Minister now seems to concede. Remember the federal stockpile had only 100,000 N95s entering the pandemic.
But setting this aside, I believe the chief medical officer of health and her immediate predecessor failed in their responsibility under section 12 of the Public Health Agency of Canada Act to warn Parliament and Canadians that we weren't ready, that we didn't have enough personal protective equipment, especially N95s.
When Dr. Tam's office and that of her Ontario counterpart were being established in 2004, Justice Campbell advised both governments to make chief medical officers of health the public guardian by giving them the rights, duties and independence to speak out on public health risks. Both levels of government listened and the wording of section 12 of the federal act and the equivalent section 81 of the Ontario act are virtually identical. Over the past five years Dr. Tam and her immediate predecessor have issued seven reports to Parliament and the public on a variety of important public health issues, including on alcohol and substance abuse. None, however, examined whether we were ready for an existential public health threat like the pandemic, including whether we had enough N95 respirators, despite the explicit intent of the act.
In view of the systemic failure I recommend that Parliament consider amending the Public Health Agency of Canada Act on an urgent basis to require the chief medical officer of health to report in detail each year on the state of Canada's preparedness for the future of public health emergencies and to request that the Auditor General of Canada independently evaluate on a regular basis the Public Health Agency of Canada's ability to monitor and evaluate our public health emergency preparedness.
Thank you.