Good morning. Thank you for the invitation to meet with your committee and provide my thoughts about Canada’s response to the COVID-19 pandemic. I am speaking to you as an individual and I am not formally representing any particular group. I will spend most of my time describing the research group and the research networks I lead, since my message to you is reasonably short and the details of my research activities will provide you with greater context for the questions you may have for me.
I am a professor of pediatrics and microbiology and immunology at Dalhousie University. I am also a pediatric infectious diseases subspecialist at the Izaak Walton Killam Health Centre in Halifax, Nova Scotia. I have been in Halifax for 35 years, after growing up and undertaking all of my training in the United States. I spend approximately 25% of my professional time doing clinical work, 25% in teaching and administrative work, and the remaining 50% dedicated to vaccine-related research. My declarations are that I am a researcher and I receive research funds from multiple sources, including federal and provincial funding agencies, foundations and vaccine manufacturers. I also serve on federal and provincial government advisory bodies, and ad hoc industry advisory panels. One such federal committee currently is the Canadian immunity task force.
As part of my 50% research time commitment, I am the director of the Canadian Center for Vaccinology, or CCfV for short. CCfV is a research collaboration of investigators at Dalhousie University, the IWK and the Nova Scotia Health Authority. While primarily based in Halifax, CCfV also has investigators from St. Francis Xavier University and other Atlantic academic centres. CCfV is organized into three groups.
The discovery group comprises basic scientists, including virologists, bacteriologists and immunologists, with the goal of creating new and improved vaccines, new adjuvants and new vaccine delivery systems, and understanding the immune response to infectious disease pathogens. The discovery group is actively involved in COVID-19 vaccine development. It is establishing the animal model for COVID-19 infection and evaluating biomarkers of COVID-19 disease.
The evaluation group is made up of clinician scientists, epidemiologists and statisticians who do epidemiological studies [Technical difficulty—Editor]. As one of the primary vaccine trial sites in Canada, our group is busy preparing for multiple phase one COVID-19 studies.
The policy, programs and implementation group is our most diverse group, comprising nursing researchers, pharmacists, health economists, bioethicists and experts in health law, anthropology, psychology, pediatrics, internal medicine and public health. This group endeavours to understand how and when vaccines are used, understand attitudes amongst the public and providers, and evaluate the effectiveness of public health policy and programs. The PPI group has CIHR and SSHRC funding to explore the effects of public health COVID-19 policy on various communities in Canada and overseas.
As part of my research program, I am the nominated principal or co-principal investigator for two national networks relevant to vaccine research. The designation “nominated PI” is a term that designates a person as responsible for administering the network in a fiscally responsible manner and meeting the funder’s objectives. It does not imply that the person is the one doing most of the research, which in fact gets done by the co-PIs and co-investigators.
IMPACT, the immunization monitoring program, is a Public Health Agency of Canada-funded surveillance network administered by the Canadian Paediatric Society at 12 of the country's pediatric hospitals, accounting for 90% of the tertiary care pediatric hospital beds in Canada. IMPACT has been in existence for 30 years and it undertakes surveillance for selected vaccine-preventable, or soon to be vaccine-preventable, infectious diseases and adverse events following immunization that are severe enough to require hospitalization.
The second network is the Canadian Immunization Research Network, which is also called CIRN. CIRN was originally established in 2009 as the PHAC-CIHR Influenza Research Network, or PCIRN, to build Canadian research capacity in anticipation of a predicted influenza pandemic, which happened to be declared within one week of receiving funding. PCIRN was granted $3.5 million a year for three years, which was increased to $4.5 million a year when the pandemic was declared.
PCIRN was highly successful at undertaking rapid clinical trials of candidate pandemic flu vaccines, undertaking large-scale safety surveillance during the initial vaccine rollouts and establishing the safety of vaccination in individuals allergic to eggs, amongst many other studies. PCIRN was so successful that it was decided at the time of its renewal to expand its mandate from just influenza to all vaccines of public health interest, changing its name from “Influenza Research Network” to “Canadian Immunization Research Network” and cutting its budget in half from $4.5 million a year to $2.2 million a year.
Here's my first message.
While I'm very appreciative of the substantial research support for PCIRN and the continuing research support for CIRN, pandemics and emerging infectious diseases are not solved. They are mitigated and will continue to occur. Over the last 11 years, globally, the WHO has declared public health emergencies of international concern for H1N1, influenza, polio, Zika, Ebola—twice—and now, SARS-CoV-2. Cutting back on public health readiness between crises slows the response to the next emerging disease. While paying for readiness may seem wasteful and an easy target when cost-cutting is occurring, eventually a price has to be paid. Once the COVID-19 pandemic passes—and it will pass—we should not drop our guard in regard to pandemic research capability.
What is CIRN doing now, in the current COVID-19 pandemic?
CIRN is organized as a network that comprises eight subnetworks. These networks span the country. Over 100 investigators at over 30 institutions are members of CIRN. The CIRN networks are either actively engaged in the COVID-19 research response or are poised to participate once vaccine candidates are identified.
The serious outcomes surveillance network of adult acute care hospitals has already received supplemental funding to undertake COVID-19 surveillance at adult hospitals and collect specimens to understand how people develop immunity and biomarkers that might predict patients who develop severe disease.
CIRN's clinical trials network, which performed phase one and two studies on Canada's Ebola vaccine five years ago, is currently designing phase one and phase two studies for candidate COVID-19 vaccines. Over 10 groups have approached CIRN to undertake phase one studies for them, and five are in the active planning stage.
CANVAS, the vaccine safety network, is prepared to undertake broad surveillance to detect any vaccine-associated adverse events during the early phases of a vaccine's rollout. CIRN's social sciences and humanities network will examine the public's response to novel vaccines developed to prevent COVID-19.
CIRN's other networks, including the reference laboratory network, the modelling network, the special immunization clinic network and the provincial collaborative network will also be heavily engaged as vaccines become available.
What's going well with Canada's COVID-19 public health and research response?
I am very pleased with Canada's aggressive research response to this pandemic, with rapid calls for proposals and awarding of research funds. The tri-council competitions have been well publicized and well managed, and the amount of funding has been substantial. Could it be more? Sure. Given that virtually all research, except for COVID-19-related research, was brought to a halt in Canada because of the health restrictions in the workplace, including in universities. This means that all of Canada's research talent turned to focus on COVID-19.
Despite increased levels of funding, the success rate of grants at the granting councils did not rise, the scores required to be successful did not fall and research that received very high peer reviews still did not get funded. Message two is that Canada has a lot of talent, and if everyone focuses on a single topic, it takes a lot of money—even more than the impressive amount already committed—to fund all the projects that are worthwhile.
My next point is a bit beyond my scientific expertise and more of a personal observation. A key aspect of Canada’s successful public health and research response to the pandemic is that it has not become politicized. Canada, to date, has maintained the commitment to let the best scientific evidence guide its public health policy and research priorities. I think this is a critical factor in the control over the pandemic that we have achieved to date and our best effort to maintain control while awaiting a vaccine solution.
To close, while I don’t think there is anything that has gone poorly in Canada’s response, I do think there might be room for improvement. In the vaccine research and development arena, the process under way may have been more effective if there were a single person tasked to coordinate all of the activities required to bring a new vaccine into general use.
While all necessary activities are under way, some have been delayed, and information has not always been readily available when needed. There has been no single source for all information, or a directory to point someone in the right direction for answers about what are the required next steps. This leads to processes at times being established after actors in the field have already had to make critical decisions, leading to false starts and wasted time and effort.
A central clearing house established early in the pandemic in anticipation of vaccine development might have smoothed the process and made it more transparent to all involved parties. However, this is a criticism or suggestion regarding logistics in an otherwise very effective response to the COVID-19 crisis.