Health Committee on Feb. 1st, 2021

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to the Canadian Public Health Association's Mr. Ian Culbert, executive director.

Go ahead, Mr. Culbert, for six minutes.

[Ian Culbert, Executive Director, Canadian Public Health Association]

Thank you, Mr. Chair.

Good afternoon, honourable members of Parliament. Thank you for the invitation to appear before you today.

On behalf of the Canadian Public Health Association, I want to begin by expressing our gratitude and support for the public health officials and health workers across our country involved in the response to COVID-19. In communities across our country, they are doing everything in their power in this unprecedented time to help Canadians stay safe and to give them the hope that there is light at the end of the tunnel.

I'm pleased to announce that later this week, CPHA will be releasing its “Review of Canada's Initial Response to the COVID-19 Pandemic”. This report will provide a non-governmental perspective and overview of the public health measures taken to date. It is not meant to provide a detailed analysis of all actions taken, however. I will be pleased to provide the clerk of the committee with access to the review as soon as it is available so that it can be shared with members of this committee.

The review will contain a number of recommendations on topics of interest to this committee and relevant to addressing the second wave of the pandemic. These include data collection, testing, contact tracing and the need for a national approach to outbreak management. Whereas our data collection ended in mid-September, the review does not address the issues of vaccination that are of interest to this committee today. I will address some of these challenges now.

Clearly, the COVID-19 pandemic is Canada's largest public health crisis in over a century. We are seeing weaknesses in our systems as we attempt to secure timely delivery and dissemination of vaccines. Canada needs to develop the flexible, efficient national research and production systems needed to reduce our reliance on international vaccine manufacturers and to meet the needs of Canadians while positioning ourselves as a good international economic partner. To this end, CPHA recommends strengthening basic and applied research capabilities to support infectious disease research along with vaccine development and production requirements. We also need to rebuild our domestic supply chains and manufacturing capacities for vaccine production. Finally, the federal government, in collaboration with provincial and territorial governments and other stakeholders, needs to develop, test and implement national standards and strategies for the distribution of vaccines as part of our emergency response plans.

This pandemic has also highlighted the limits of our health care and public health systems. Within government, the delivery of health services, as you well know, is the responsibility of the provinces and territories, with the federal partner having responsibilities for leadership, collaboration and international relations, among others. The challenge is that the federal responsibilities for public health are not well defined through a policy, legislative or regulatory framework. This situation must change if our country is to respond efficiently and effectively to future public health challenges. CPHA recommends the development of a more unified structure that provides a national approach to public health while respecting provincial and territorial responsibilities. This goal could be achieved through the development of federal legislation for public health, a Canada public health act, with clear roles and responsibilities defined for all governments and stakeholders. Such legislation would require a national funding accord that incorporates performance measures for the delivery of public health services according to national standards.

The pandemic has demonstrated the strengths, resilience and weaknesses that exist within governments' collective abilities to meet the vaccination requirements of this country. Lessons can and must be learned from the past in order to end the current pandemic and provide the tools and capabilities to respond better to future emergencies. The current setback in vaccine deliveries is not unexpected. We are dealing with a novel virus, new vaccines, new technologies and new production processes. The manufacturers need time to expand their production facilities to meet the worldwide demand for vaccines. It must be viewed and conveyed to the public as an example of a short-term delay for long-term benefits.

When I spoke to this committee last April, I noted that how we respond as individuals may be the single most important factor in how well we fare as a country. As much as the hope that is provided by vaccines is the incentive to keep going, we have months of public health orders that we will have to continue to live through before this is over.

For better or for worse, this is playing out as we expected.

This is a deadly virus that preys upon the most vulnerable in our communities. Now is the time for Canadians to continue to make personal sacrifices for the common good, and elected officials at all levels must set that example. This is an unprecedented situation. As such, our response is imperfect.

I do not believe that Canadians expect perfection, but they do want to know that their elected leaders are working together with public health officials to solve the problems that arise.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you very much, Mr. Culbert.

We'll go to the COVID-19 Immunity Task Force.

Go ahead, Dr. Evans.

[Dr. Timothy Evans, Executive Director, COVID-19 Immunity Task Force]

Thank you very much for the opportunity to present today. I'll say a few words about Canada's COVID-19 Immunity Task Force.

The task force was formed in late April 2020 by the Government of Canada with a two-year mandate. Working virtually, the task force leadership group, co-chaired by doctors Catherine Hankins and David Naylor, is a representative set of volunteer experts from across the country who are focused on understanding the nature of immunity arising from the novel coronavirus that causes COVID-19 and understanding the prevalence of the infection in the general population as well as specific communities and priority populations.

The task force and its secretariat have been working closely with a wide range of partners, including provincial, territorial and federal governments, public health agencies, academic institutions, health organizations, research teams, other task forces, communities and stakeholders.

Most recently, the task force has been asked to take a major role in supporting vaccine surveillance for effectiveness and safety as the rollout of vaccines begins.

Our overriding objective is to generate data and ideas that inform interventions aimed at slowing and ultimately stopping the spread of SARS-CoV-2 in the population. We have four areas of focus, which I will describe briefly. These areas of focus are being supported through 55 studies that are currently in the portfolio of the task force.

First are seroprevalence studies, which test for the presence of antibodies that indicate a previous infection with the SARS-CoV-2 virus. These studies are ongoing as we navigate the second wave. They shed light on the level of immunity in the general population, as well as the level of immunity in priority populations such as residents of long-term care facilities, health care workers and racialized communities.

Initial studies with the blood banks in Canada, for example, reveal that at the tail of the first wave of the pandemic in May and June 2020, the level of population immunity in Canada was extremely low, at less than 1%. While that was a great endorsement of public efforts to limit the spread of infection, these low levels of immunity made it abundantly clear that across the country we remained extremely vulnerable to a second wave. Updated results in November 2020, in the midst of the second wave, suggest that while levels of immunity have risen—particularly in the Prairie provinces where they hover around 8% to 9% of the population—we are a long way from herd immunity. As such, accelerated vaccination is an urgent priority to move Canadians towards herd immunity.

A second area of focus is really understanding what immunity against SARS-CoV-2 looks like and how long it lasts. This science is happening alongside the seroprevalence studies. Results from one of the CITF-supported studies has just emerged, indicating that immunity following infection remains strong and protected for at least eight months. As the cohort of infected persons are followed further, we will get more insight on just how long immunity from infection lasts.

A third area of focus relates to immune testing, which includes, for example, research to validate dried blood spot specimen testing with made-in-Canada antibody tests that distinguish vaccine-induced immunity from post-infection immunity. These dried blood spot specimens can be used at home and are now being deployed in studies across the country to gather information about how population immunity is evolving as vaccines are rolled out.

The final area of focus is the newest. This is a focus on vaccine surveillance. The task force is supporting research partners from across Canada in a new collaboration that will monitor vaccine effectiveness and safety in the population at large and in high-priority groups.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Evans.

We go now to Medicago Inc. We have Ms. Nathalie Landry and Mr. Nicolas Petit.

Ms. Landry or Mr. Petit, please go ahead for six minutes.

[Nathalie Landry, Executive Vice President, Scientific and Medical Affairs, Medicago Inc.]

Thank you.

Good afternoon, Chairman McKinnon, Vice-Chairs Rempel Garner and Thériault, and members of the committee.

On behalf of Medicago, I would like to thank the committee for inviting us to participate today.

Medicago is a Canadian biopharmaceutical company with the mission to improve health outcomes by using its innovative plant-based technologies for rapid responses to emerging global health challenges.

Diseases know no boundaries. Medicago is working tirelessly to develop vaccines to help prevent disease, and to develop therapies to help treat those diseases.

Of course, no disease is more prevalent right now than COVID-19. We are proud to be contributing to the fight against COVID-19 by developing a made-in-Canada vaccine, which is currently in phase two clinical trials. Phase three is to be launched in the upcoming weeks.

We are proud to be a Canadian company based in Quebec City, and we make a significant contribution—

[Luc Thériault, Bloc, Montcalm, QC]

Sorry, Mr. Chair, but there's been a problem with the interpretation for a few minutes now. The interpreter is indicating that Ms. Landry's comments aren't coming through clearly because some mikes are not on mute. It would be appreciated if we could get that fixed.

I'll say it again. I don't understand how there isn't a mechanism to detect and flag the issue immediately, without my having to interrupt the witness every single time. I find it very uncomfortable to have to do that, so my apologies to Ms. Landry.

[The Chair, Liberal, Ron McKinnon]

I understand, Mr. Thériault.

I did not hear your point of order, if you raised one. I'm not really in a position to know when there are problems with the French translation, so I welcome your intervention to say so when the time comes.

I find that with Ms. Landry switching back and forth between English and French, there's a bit of a gap between each time.

Ms. Landry, if you could pick one or the other, we'd be probably better off, if that's okay with you.

[Nathalie Landry]

Yes.

[The Chair, Liberal, Ron McKinnon]

We shall carry on.

Hopefully, Mr. Thériault, you'll get better translation this way.

Please go ahead, Ms. Landry.

[Nathalie Landry]

My apologies in advance, but most of my notes are in English, so I'll carry on in English.

Medicago uses a proprietary plant-based technology to develop a vaccine and therapeutics. Our vaccines are virus-like particles that mimic the shape and the appearance of the virus without being infectious or being able to cause any disease. Because they look like the virus, the human body recognizes them and raises an immune response.

Our proprietary technology is extremely versatile and positioned to support rapid response to pandemics. It has been developed to support the fight against pandemic threats and other emerging diseases.

As soon as the genetic sequence of a virus becomes available, Medicago can develop clinical grade material for a vaccine candidate in only a few weeks—an important feature for this pandemic as we see new coronavirus variants emerging. During the current COVID-19 pandemic, Medicago has reallocated nearly all its resources to develop a vaccine against COVID-19 and to accelerate its path to increasing Canada's domestic vaccine manufacturing capacity.

In addition to our COVID-19 program, Medicago is advancing a number of programs in public health, including a pandemic and a seasonal influenza vaccine currently under review by Health Canada.

With respect to our COVID-19 vaccine program, I'm pleased to share some highlights of our phase one trial that has been completed. The data have demonstrated that 100% of the study participants who received an adjuvanted formulation of the vaccine developed high levels of neutralizing antibody response and cell-mediated immune responses after the second dose.

Our phase two trial is approaching completion, and based on these results and regulatory approval, phase three will be launched in the upcoming weeks.

The phase three portion of the trial will enrol 30,000 subjects in more than 10 countries to make sure that we have diversity within our trial, and the results of this phase three study are expected this spring. We expect regulatory approval for the vaccine this summer, at the point where we will start delivering doses to the Canadian government.

The Government of Canada's support has been instrumental for Medicago's COVID-19 vaccine development program and the construction of our large-scale manufacturing facility. It will ensure availability of Canadian-made vaccines to the population and provide much needed domestic manufacturing capacity for vaccine, antibodies and other immunotherapies.

In addition, Canada's advance purchase order of our vaccine has allowed Medicago to reserve supply for Canada and provide the security needed to pivot resources from other programs and to focus on COVID-19 vaccine development and production.

I want to take this opportunity to thank government leaders and partners who have made this investment possible: the Public Health Agency of Canada; Innovation, Science and Economic Development Canada; Public Services and Procurement Canada; and the Government of Quebec. We are very grateful for your support and look forward to continuing to work with our government partners to protect Canadians from the current COVID-19 outbreak and future public health emergencies.

As we look to critical factors involved in preparing for pandemics, it might be useful to structure our response according to three major axes: time, economics and competencies. Pandemic response requires long-term planning given the many years required to develop a vaccine platform and build domestic infrastructure. Private-public partnership provides strong synergies. While Canada needs to secure technology and domestic production capacity, industry requires terms to ensure sustainability and to encourage private investment. Competencies are critical to ensure a domestic response chain from early research to clinical development, production and distribution.

Government—

[The Chair, Liberal, Ron McKinnon]

Ms. Landry, I must ask you to wrap up ASAP, please.

[Nathalie Landry]

Yes.

In conclusion, we wish to reiterate our appreciation to the Government of Canada for its support. We are firmly committed to delivering vaccines to our population and serving Canadians to the betterment of our national public health, and we will welcome any questions.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you very much.

Now we will start our round of questions. We will have time for one round of six minutes per slot. We'll start with Mr. Barlow.

Mr. Barlow, please go ahead, for six minutes.

[John Barlow, Conservative, Foothills, AB]

Thank you, Mr. Chair.

Mr. Evans, we recently found out the immunity task force was not able to complete your antibody testing to see just how prevalent COVID-19 is in Canada. It seems a lot of this was related to your inability to access serology testing because of Health Canada's delays on their approval.

Do you think there have been some serious bureaucratic hurdles that are preventing our country from having the best possible COVID-19 response?

[Dr. Timothy Evans]

You may or may not recall, but when the task force was launched in April 2020 there wasn't a single approved immunoassay at that time. The first approvals took place in May. Those were approvals for assays that required a formal blood draw from a vein. We got those into the studies as quickly as we could.

The issue of looking at how to accelerate approval and the assessment of the efficacy of immunoassays is important to do. This is not specific to Canada. In virtually every country the standards for doing this, which involve assembling panels with diverse sources of blood, not only from infected people but from people infected with other conditions, and the period over which one looks at those bloods, meaning not only when they are first infected, but seven, 14, 21, 28 days later that whole process, in my opinion, based on our experience, could benefit enormously from stronger standardization, discipline and coordination with respect to making it work much more efficiently.

We did not have any point-of-care assays approved by Health Canada. Those are assays that can be used with a drop of blood from the finger. These assays can be used at home, so this allows you to test populations in a much easier way than to have people come and have a formal draw of blood with a needle. We worked very hard for a national microbiology laboratory to get an assessment of the validation of the dried blood spot. This we achieved in September. But this, again, is an area where I think if we looked at the process of getting the accreditation or the authorization that this was a valid and useful test.... I'm sure there's room for improvement.

The short answer is, yes, I think there's room for improvement in getting our testing assessed for accuracy more quickly.

[John Barlow, Conservative, Foothills, AB]

Mr. Evans, do you know our national capacity to test for the variants?

[Dr. Timothy Evans]

I don't know the exact capacity. I've been part of discussions with an effort to mobilize capacity for tracking the variants. It's multi-faceted related to sequencing capacity, and also linking this to follow-up of the implications of the variant in its impact on transmission, as well as the disease profile of people who have those variants. I'm not in a position to comment on the scale of that capacity at this point, other than to say I've been part of conversations where plans are under way to scale it up.

[John Barlow, Conservative, Foothills, AB]

Is it adequate, in your opinion, or is it not adequate? Can you give me a quick answer?

[Dr. Timothy Evans]

Canada has very impressive sequencing capacity through a set of institutions. Once they are joined together, we should certainly have that capacity across the country.

[John Barlow, Conservative, Foothills, AB]

This is the last question, Mr. Chair. It's for Mr. Evans again.

How can we understand immunity if we can't test for those variants? How are we going to set that baseline if we can't test for the variants that are emerging?

[Dr. Timothy Evans]

It's a very good question. We're looking to understand the immune implications of the variants. This is a combination of observing the patterns of the variants in the population in terms of the impact they have on transmission and on the disease pattern, but also carrying out more laboratory-based studies that help us to understand how these variants might act differently from the other forms of the virus that we've been looking at thus far.

Everyone in the world is in a similar place on this front. There's an opportunity, not only in Canada but globally, to draw on that scientific enterprise to understand as quickly as possible what the consequences of these variants are for immune protection.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Barlow.

We go now to Ms. Sidhu. Please go ahead, for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair. Thank you to all the witnesses for being here.

The federal government is still expecting to get six million doses by the end of March, with the two vaccines presently authorized. We expect that 13 million Canadians will be vaccinated before the summer, and we are on track to meet our target of 17 million doses by the end of September. Of course, this will go faster as even more vaccines are authorized. That is why we are hopeful that they will be.

My question is for Mr. Culbert. Vaccines are being administered by hospitals and public health agencies. As the supply increases over the coming weeks, do you think the agencies will be able to keep up with the demand, or do you think other locations of delivery, like pharmacies and doctor's offices, will need to be utilized?

[Ian Culbert]

First, it depends on which vaccines we're talking about. The need to track and have in an electronic registry a record of who has been vaccinated, to schedule their second dose and be able to track any adverse events, is going to be crucial. My concern about increasing the number of tracks of potential sites for vaccination is that it's so many more systems that have to be brought on board to track that information.

I would support greater investment in mass public health vaccination clinics, in multiple sites but organized by public health and bringing in as many vaccinators as you can. If pharmacists want to be part of the vaccination movement, they should be, but under the umbrella of mass vaccination clinics run by public health.