Health Committee on Feb. 1st, 2021

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome, everyone, to meeting number 16 of the House of Commons Standing Committee on Health.

The committee is meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.

Today's meeting is taking place in a hybrid format, pursuant to the House order of January 25, 2021, and therefore members are attending in person in the room, and remotely using the Zoom application. The proceedings will be made available via the House of Commons website. The webcast will always show the person speaking, rather than the entirety of the committee.

Today's meeting is also taking place in the new webinar format. Webinars are for public committee meetings and are available only to members, their staff and witnesses. Members may have remarked that the entry to the meeting was much quicker, and that they immediately entered as an active participant. All functionalities for active participants remain the same. Staff will be non-active participants only, and can therefore only view the meeting in gallery view.

I would like to take this opportunity to remind all participants to this meeting that screenshots or taking photos of your screen is not permitted.

Given the ongoing pandemic situation and in light of the recommendations from health authorities, to remain healthy and safe, all those attending the meeting in person are to maintain two-metre physical distancing, must wear a non-medical mask when circulating in the room—it is highly recommended that the mask be work at all times, including when seated—and must maintain proper hand hygiene by using the hand sanitizer provided at the room entrance.

As the chair, I will be enforcing these measures for the duration of the meeting, and I thank members in advance for their co-operation.

For those participating virtually, I would like to outline a few rules to follow as well.

Members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. You have the choice, at the bottom of your screen, of “floor”, “English” or “French”, and with the latest Zoom version, you may now speak in the language of your choice without the need to select the corresponding language channel. You will also notice that the platform's “raise hand” feature is now in a more easily accessed location on the main toolbar, should you wish to speak or alert the chair. I will note that the main toolbar is on the bottom of the participant's pane.

For members participating in person, proceed as you usually would when the whole committee is meeting in person in a committee room.

Before speaking, please wait until I recognize you by name. If you are on the video conference, please click on the microphone icon to unmute yourself. Those in the room, your microphone will be controlled as it normally is by the proceedings and verification officer.

A reminder that all comments by members and witnesses should be addressed through the chair. When you are not speaking, your mike should be on mute.

With regard to a speaking list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they are participating virtually or in person.

I would like now to welcome our witnesses.

As an individual, we have Professor Amir Attaran, Faculty of Law and School of Epidemiology and Public Health at the University of Ottawa. We have Dr. Isaac Bogoch, physician and scientist, Toronto General Hospital and University of Toronto. We have Professor Marc-André Gagnon, associate professor, School of Public Policy and Administration, Carleton University. We have the Honourable Paul Merriman, Minister of Health, Government of Saskatchewan.

I will now invite the witnesses to make a six-minute statement, and I will start with Dr. Attaran, please, for six minutes.

[Professor Amir Attaran, Professor, Faculty of Law and School of Epidemiology and Public Health, University of Ottawa, As an Individual]

Good morning, Chair.

I'm Amir Attaran. I'm a professor of law and public health at the University of Ottawa. I want to give you some of my background so you'll know why I'm speaking on the things I am.

I'm a scientist by training. My Ph.D. is in cell biology and immunology from Oxford University. I'm a lawyer from UBC. I taught public health at Yale. I taught government at Harvard. I'm a bit of a generalist.

In my work, I've advised organizations such as the World Health Organization, the World Bank, the UN development programme, Médecins sans Frontières and various pharmaceutical industries on health. In fact, I worked in the pharma industry, at Novartis, most interestingly, on a project where we had to scale up drug production by 6,000% in one year and solve the manufacturing and distribution problem.

Now, that reminds me of where we're at, because we now have a problem of too few vaccinations in the country. Per capita, Canada is lagging behind most of our peers. We've had fewer vaccinations than the U.S., the U.K. or the European Union. This is occurring for reasons I warned about in Maclean's magazine last August, and I'm very unhappy to see much of that proved correct.

I'm going to point to three areas where I think all parties agree that things are unacceptable. My goal is to try to tell you how you work together on those three issues.

The first is transparency, which is really just pathetically lacking. The current government I think has done a terrible job on the transparency of its efforts. On the work of the vaccine task force, for instance, none of the meeting minutes are public. It appears not to have met since last October. None of the conflict-of-interest declarations signed by the members are public.

We don't really know what's going on in that committee, and it doesn't inspire confidence. You can't have the most important science decisions in generations being made secretly. That has to end, and if it doesn't, my fear is that it will contribute to a bad-tempered political environment, where you fight with each other so much that you don't solve the substantive problems, and that wouldn't be desirable for Canadians.

Point two, the biggest substantive problem is manufacturing. Canada needs to build resilience to supply interruptions for vaccines. We've seen what happens when our supplies are cut by Pfizer and Moderna. We've seen what happens with the European Union potentially shutting off exports when Canada is 100% dependent on European exports of vaccines right now.

Countries like Australia, India, Japan and Brazil are manufacturing. The way they do it is that they voluntarily license and contract the production of the vaccines. This is, by the way, how the manufacturers themselves work. Moderna, Novavax and AstraZeneca are producing that product not in their own facilities, for the most part, but by contracting out production to other companies you've never heard of, like Lonza, Fujifilm and Emergent.

I think this is an important question for Parliament to grapple with: Why not pay those same contractors of the vaccine firms to lay on another batch for Canada, particularly in North American facilities where the supply interruptions would not be the same as with the European Union—

[The Chair, Liberal, Ron McKinnon]

Excuse me, Dr. Attaran. You need to speak a little louder and perhaps a little more slowly for the translators.

Thank you.

[Prof. Amir Attaran]

There are long-term capital investments needed to solve this. What there needs to be are contracts made with suppliers like Lonza, Fujifilm and Emergent that have the equipment and technology and that indeed are making vaccines for the companies you've heard of, like Moderna and AstraZeneca. Let's just amp that up.

The third point is, where is Canada's mass vaccination campaign? It's so scattershot right now. There's no plan for a national vaccination campaign once we have sufficient vaccines, and that, to me, is just a tragic failure. To put it in context, in 2014, Bangladesh, one of the poorest countries in the world, vaccinated 52 million kids in just three weeks. That's more than the population of Canada.

In 1947—old technology—New York City vaccinated five million people for smallpox in two weeks. These large vaccination campaigns are able to be done even in the world's poorest places. They happen regularly. That model of organization is one that should be considered for Canada, such that perhaps in the summer or in the fall, if there is an abundance of vaccines, they could be delivered campaign-style to millions of people within a week.

Any one of these three topics I've discussed—the transparency, the manufacturing, the campaign—I could talk about for an hour. I won't. I'll stop here and I'll invite your questions on those three or anything else within my expertise that you need to know.

[The Chair, Liberal, Ron McKinnon]

Thank you, doctor, we're well aware of your time.

We'll go now to Dr. Isaac Bogoch.

[Luc Thériault, Bloc, Montcalm, QC]

Just a second, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

Go ahead, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

I cannot continue to take part in committee meetings if the interpreters are unable to interpret. The excuses range from people not muting their microphones to sound checks not having been done to make sure the interpreters can hear the witnesses clearly.

Regardless, I want you to know that there is an issue right now. Throughout Mr. Attaran's entire presentation, which was highly relevant, the interpreter stopped speaking a number of times because she couldn't hear what he was saying clearly enough to interpret his comments. I, however, could hear Mr. Attaran perfectly when the interpreter stopped speaking. She flagged the problem repeatedly during his statement.

It baffles me that there is no mechanism to ensure the clerk receives the message quickly so you can deal with the problem right away. Even if I wanted to listen to the speaker in English, I couldn't. All I hear is the interpreter saying that she can't interpret what is being said.

As a member of the linguistic minority of Canada—and North America—I am just as entitled to hear what witnesses are saying.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

I would certainly advise that if you're not getting translation to speak up as soon as you can on a point of order, and we'll try to deal with that as proactively as we can. I did get a note from the clerk during Dr. Attaran's testimony that it was too fast and too quiet, so I did ask him to speak louder.

Dr. Bogoch, I encourage you to speak slowly and loud enough. All of the witnesses have gone through the sound check.

Dr. Bogoch, do you have a headset?

[Dr. Isaac Bogoch, Physician and Scientist, Toronto General Hospital and University of Toronto, As an Individual]

I have done the sound check, and I've been told that it's A-quality. I do not have a headset, but I do have a special microphone that is of high quality.

[The Chair, Liberal, Ron McKinnon]

Mr. Thériault, I am certainly alert to your problem, and I am doing the best I can to ensure that translation happens. Please do not hesitate to raise a point of order if you're not getting translation.

Dr. Bogoch, please go ahead for six minutes.

[Dr. Isaac Bogoch]

Thank you so much. Good morning, everyone. My name is Isaac Bogoch. I'm an infectious diseases physician and scientist based out of the Toronto General Hospital and the University of Toronto. Thank you for inviting me to speak at this committee meeting regarding the COVID-19 second wave in Canada.

The focus of my few minutes is to discuss an exit strategy from this wave, and from the pandemic in general, with an emphasis on vaccination but also touching on other issues including non-pharmaceutical interventions.

The ultimate goal here is to halt our second wave and to prevent further waves of COVID-19. Now, most regions of Canada have emerged from peak cases in December or early January and are seeing a steady decline or a plateau in cases due to our current control initiatives. While this is laudable, we still have a long way to go. Vaccines are trickling in, but we won't really be able to really start massive expansion of these programs until the spring, so programs are appropriately focusing on those at risk or at greatest risk of severe outcomes.

I want to touch on three big topics: what's working in our favour; what is working against us; and how we navigate the winter, the spring and beyond.

Let's start with what's working in our favour. Number one, we have vaccines. Of course, the current short-term slowdown is preventing expansion of these programs, but we still have some and we're making good use of what we have.

Just to state the obvious, the sooner we ramp up these programs, the better. All vaccines approved by Health Canada and those under consideration have excellent efficacy against the virus, including the variant discovered in the U.K., while there is lower efficacy on other variants of concern—for example the one discovered in South Africa. However, the vaccines still appear to reduce infection, prevent severe illness, prevent hospitalization and prevent death—all very important metrics.

The second thing working in our favour is weather. Believe it or not, weather in Canada is actually working in our favour. As we leave winter, as we enter the spring and summer, warmer weather means less contact in indoor settings, where the vast majority of virus is transmitted. These fewer high-risk contacts add up at a population level and are going to help.

The third thing is that our current public health measures are working in much of Canada, and in general, Canadians are adhering to them.

What's working against us? Number one are the variants of concern. For example, the variant discovered in the U.K.—that's the B117 variant—is more transmissible and has a strong foothold in Canada. We have to respect this. We have to take it seriously. We need to drill down on our current control efforts until vaccine rollout is more widespread.

The second thing working against us is anything that jeopardizes vaccine delivery. This is way above my pay grade, and I'm going to leave it to you to sort that out.

The third thing is vaccine hesitancy. This is pronounced in some communities, but it's still important, and we have to address it.

The fourth thing is targeting misinformation and focusing on better communication, from both official and non-official sources. This is beyond the scope of my time, but it's still a huge problem that's impacting the pandemic in Canada and beyond.

The fifth thing is COVID fatigue. It's real. It's permeating all aspects of Canada. We can't let our guard down, especially as we see a finish line on the horizon.

Lastly, how do we stickhandle our way through the winter and into the spring and beyond?

First, we need to be very careful, and have a careful and measured reopening strategy, especially while vaccines are slowly being rolled out. The variant discovered in the U.K. will make this more challenging, but it can be done. It's foolish to lift public health measures if the drivers of community infection are not addressed. Vaccine rollout will not be widespread until the spring. There's no point having more lockdowns. Lifting measures has to be done at the right time, slowly and carefully.

Second, related to the point above, is creating safer indoor environments, and that includes schools and workplaces for essential workers and those returning to work. That means integrating rapid diagnostic tests or rapid screening tests, improving ventilation in these settings, having smaller class sizes, and providing wraparound services to ensure equitable access to safety and protection, etc.

Third is vaccine distribution. Now, let's separate politics from science for a second. It may be an unpopular political opinion, but it makes sense in terms of medicine, science and public health to divert vaccines from low-burden areas of the country that are able to control the virus to more heavily impacted areas while there is still a shortage.

Fourth is vaccine supply in the short term. Health Canada has to conduct its evaluation independently, but the faster we vaccinate, the faster we'll be out of this mess. Johnson & Johnson, Novavax and AstraZeneca are three products with excellent phase three clinical trial data. We have contracts with them. They are sorely needed.

Last is a long-term strategy. It's crucial to support Canadian scientists and Canadian industry in homegrown vaccine production. This is a major weakness and a major health security issue.

We have the talent and capability here, and it's long past time to enhance and expand these programs.

It's hard to sum up all that's required to strategically navigate the second wave in five minutes, but I hope that we can continue this conversation. I thank you for your time.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Bogoch.

We go now to Monsieur Gagnon, associate professor.

Go ahead, Professor, for six minutes.

[Dr. Marc-André Gagnon, Associate Professor, School of Public Policy and Administration, Carleton University, As an Individual]

Thank you, Mr. Chair.

Good morning.

My remarks will focus on COVID-19 vaccines as they relate to research and development and manufacturing.

I am an associate professor in Carleton University's School of Public Policy and Administration. My research focuses on the political economy of the pharmaceutical sector. I have more than 150 publications to my credit, ranging from scholarly articles, book chapters and research papers to technical reports and professional publications. Apart from my role in 2020 as an expert witness for Justice Canada in a Superior Court of Québec case involving the regulation of patented medicine prices, I have no conflict of interest to disclose.

When the COVID-19 pandemic was declared, it was impressive to see researchers around the world apply the principles of open science and work together to systematically share data, primarily to sequence the viral genome, monitor the virus's evolution and variations, and produce protective and screening equipment.

In March 2020, the Canadian government passed an act respecting certain measures in response to COVID-19, or Bill C-13. Under the legislation, compulsory licensing was permitted for a period of six months in relation to any technology that could play a role in the response to COVID-19, the idea being to overcome potential shortages. The provision was not renewed in September 2020, but the federal government can do so at any time, as needed.

In May 2020, the World Health Organization, or WHO, launched the COVID-19 Technology Access Pool, or C-TAP, based on the principles of open science. The purpose of the pool was to support the sharing of technological knowledge and know-how relevant to the fight against COVID-19. In addition, the Medicines Patent Pool, MPP, funded by Unitaid, expanded its mandate to facilitate the sharing of health technology patents that could contribute to the response to COVID-19.

In the beginning, technological co-operation and data sharing were thought to be guiding the global scientific effort, to help each country maximize its COVID-19 response. Unfortunately, old habits die hard, and private science, patents and monopolies on technology quickly prevailed. To date, no company has agreed to share its technology with C-TAP or MPP. Instead, each firm is working behind closed doors to maximize future revenues.

Even though governments invested more than $14 billion in the development of vaccines, the private sector's total monopoly over the vaccines continues to go unquestioned. For example, even though Moderna's vaccine was fully funded through public investment, the company has a monopoly on the vaccine because it owns the patent. Moderna is also charging the highest price of any of the vaccine makers, garnering it the Shkreli Award, a prize handed out every year to the worst profiteers in health care.

On its end, Canada launched the COVID-19 Vaccine Task Force in the summer of 2020, to provide the government with strategic advice on vaccine matters. The lack of transparency around the task force and the conflicts of interest related to its members have been decried by numerous experts. Microbiologist Gary Kobinger even resigned from the task force in protest. In its recommendations, the task force seems to have put companies' proprietary rights above overall public health needs.

That has given rise to the current reality: countries tripping over one another for first access to vaccines. Every country is trying to convince vaccine makers to sell it doses over the country next door, and to deliver those doses as soon as possible. Forget about global public health priorities; it's every country for itself. Welcome to vaccine nationalism.

Canada plays a pretty good game of vaccine nationalism, mind you. Canada is the country that secured the largest number of doses, equivalent to 500% of what it actually needs. Under the current agreements, Canada should be one of the first countries to achieve herd immunity through vaccination.

Although Canada has a flair for vaccine nationalism, the game, itself, is extremely problematic. The production delays at Pfizer-BioNTech and AstraZeneca have created tremendous international tensions. Instead of working together to produce the most vaccines possible, countries are working against one another, letting vaccine makers' priorities dictate the global distribution of vaccines.

Canada has the capacity to produce vaccines, so why is it not leveraging that capacity to help fight COVID-19?

Countries such as India and South Africa are calling on the World Trade Organization to suspend intellectual property rights related to COVID-19 technologies, to facilitate knowledge sharing and increase vaccine production during the pandemic. Nevertheless, Canada, the United States, Europe, the United Kingdom and Switzerland are categorically opposed to the suspension of those rights. In many ways, it appears that Canada has chosen to be part of the problem, instead of the solution.

I would be happy to answer any questions you have.

[The Chair, Liberal, Ron McKinnon]

Thank you, Professor.

We go now to the Honourable Paul Merriman, the Minister of Health for the Government of Saskatchewan.

Minister, please go ahead. You have six minutes.

[Paul Merriman, Minister of Health, Government of Saskatchewan]

Thank you for the opportunity to speak today.

If this meeting had taken place a week ago, my message today would be much more encouraging. Until about a week ago, Saskatchewan had been receiving a steady supply of vaccines from the federal government. While our provincial vaccine administration plan continues to be very effective, we are now virtually at a standstill with no vaccines having been delivered to Saskatchewan in over a week. Limited quantities are now expected in the next few weeks.

The vaccines we are receiving are going into the arms of Saskatchewan people as quickly as possible. Saskatchewan has the highest percentage of vaccines administered amongst the provinces. In fact, we have now administered 108% of the vaccines we have received. I know this sounds like a mathematical impossibility, but it's because our very efficient health care workers have been able to extract an extra dose out of some of the vials of the vaccine. I'll come back to that in a second.

This efficiency has lead us to a debate about relabelling the vials, which is a move that Saskatchewan certainly does not support.

I want to talk you through a brief history of our vaccine rollout in Saskatchewan to date. When Health Canada formally approved the Pfizer vaccine in December, we were ready. That same day we announced our vaccine delivery plan. As with many provinces, it was based largely on the national advisory committee and immunization guidelines. Saskatchewan's chief medical health officer did some modifications to accommodate Saskatchewan's demographics and logistical requirements.

Phase one of our vaccine delivery plan began on December 22. It focused on immunizing priority populations that were at a higher risk of exposure to the virus and at more risk of serious illness or death. This included certain front-line health care workers, long-term and personal care home residents and staff, seniors over 70 and all residents over 50 years of age in the remote northern communities. Due to logistical requirements of the Pfizer vaccine, we initially delivered it to urban centres that had the ultra-cold freezers. The Moderna vaccine was delivered to remote northern communities.

We post Saskatchewan's vaccination numbers on the Government of Saskatchewan website and in a daily news release, so the public remains informed of our progress.

Phase two of the vaccine delivery plan is expected to being in April. This will be the beginning of our mass immunization. However, these plans are in jeopardy now. The Government of Saskatchewan's ability to vaccinate our residents is entirely dependent on a reliable supply of vaccine and reliable information about the number of vaccines we expect to receive each week. Simply put, we need more vaccines. We need more reliable information about when we're receiving those vaccines.

The flow of information is almost as important as the flow of vaccines because these vaccines are far more complex to transport, store and administer than, say, the annual flu vaccine. Our health care workers are absolutely up to the task, but as you know, Saskatchewan is a large province with many remote communities. We need reliable information to plan appointments, transportation, refrigeration and the deployment of our health care workers.

When we have received the vaccines as scheduled, our program runs extremely smoothly. However, in the past few days we have had sudden and unexpected schedule changes, causing us to have to cancel clinics in communities where they had already been announced. We need to ensure that everyone who receives their first shot is able to get their second shot in a timely manner. Again, this is extremely difficult to plan and execute without a reliable supply of vaccines and without reliable information.

The announcement that both Pfizer and Moderna are delaying expected shipments of vaccines to Saskatchewan has forced our government to revisit this plan. Saskatchewan's February 8 shipment is to be a third of what was originally promised. Prior to the recent announcements from Pfizer and Moderna, we were only able to project receiving enough vaccines in the first quarter to fully immunize about half of our priority one people. Now, completing first and second doses for our priority population is becoming challenging. Simply put, Saskatchewan will not be able to vaccinate as many people as originally planned.

Saskatchewan is asking the federal government to do everything it can to ensure the vaccines are made available as soon as possible and that the province is receiving reliable information about vaccine deliveries. Information that suddenly changes at the last minute creates more challenges.

Saskatchewan is also very concerned about Pfizer wanting to relabel their vaccine vials to say they contain six doses instead of five, which will effectively result in a reduction of the number of vaccines the provinces are receiving. Health Canada should not allow this to happen.

Earlier I indicated that our health care workers have been able to get an extra dose out of the Pfizer. However, this should be viewed as an added benefit, not the standard for counting the number of doses. On average, we have been able to get a sixth dose from about half of the Pfizer vials. For a number of reasons we cannot consistently count on getting those six doses out of every vial. That's why Pfizer should not be allowed to reduce its shipments to Canada by simply relabelling the vials and counting six instead of five doses.

My message here today is Saskatchewan has been getting the vaccines into people's arms as quickly as we get them, but we simply need more vaccines. We need to get more reliable information about when we're getting those vaccines and simply relabelling the vials does not amount to more vaccines.

We all want this pandemic to be over and things to return to normal. That will happen when we have a significant portion of our population vaccinated. Our province and our health care workers are ready to do their part, so please just get them some vaccines.

[The Chair, Liberal, Ron McKinnon]

Thank you, Minister.

We will start our questioning now. We will have time for one round.

I believe you have the first slot, Ms. Rempel Garner, for six minutes, please.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

My questions will be directed to Minister Merriman.

Minister, you just said that you're only on track to have one half of your priority one persons vaccinated by the end of March due to the supply issues.

Is that correct?

[Paul Merriman]

That is correct.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Based on the current projections that you have been given by the federal government on supply, when would every person in Saskatchewan have access to a vaccine?

[Paul Merriman]

As it sits right now, we probably wouldn't be able to have everybody have access to the vaccine until later this fall. Our priority population is about 190,000 people, which includes health care workers and seniors. We're projected to only get about 110,000 of those vaccines by the end of March.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

The assumptions that you have been told to make those projections on, do they rely on AstraZeneca's and Johnson & Johnson's being approved?

[Paul Merriman]

No. These are just the Pfizer and the Moderna vaccines. We haven't got any information as far as AstraZeneca is concerned.

In a conversation with Minister of Health Patty Hajdu last week, they were saying that AstraZeneca could come on early, but we have nothing confirmed.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Has the health minister given you any sense of how many doses of AstraZeneca would be delivered to Saskatchewan over any period of time?

[Paul Merriman]

No. We haven't received anything official from them other than it's coming, but we've heard that about a lot of our vaccine shipments right now.