Health Committee on Feb. 1st, 2021

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

We go now to Dr. Powlowski.

Go ahead for six minutes, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you.

My understanding is that the Prime Minister's statement that “all Canadians who wanted a vaccine would have one by September” is based purely on Moderna and Pfizer. Obviously, there are these other vaccines out there. We have the results of phase three large randomized, controlled trials for both AstraZeneca and Johnson & Johnson, as well as preliminary results from the Novavax study. They all look pretty good. When AstraZeneca mistakenly gave half the first dose, it had 90% efficacy. The vaccine from Johnson & Johnson—I think it was Great Britain— was about 72%, which is less than South Africa, but my understanding is that it has 100% efficacy in preventing hospitalization and death. This is certainly very significant.

Now they all need approval by Health Canada. Certainly AstraZeneca and Johnson & Johnson are more conventional vaccines—the more novel ones are Moderna and Pfizer, which have already been approved—so I would think they're likely to be approved.

There's some concern about AstraZeneca and Johnson & Johnson not living up to the 95% efficacy of Moderna and Pfizer, but these weren't head-to-head trials. There were different populations. There was the new British variant. Also I'm told, with respect to—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Doctor, you need to slow down a little bit for the translator.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Also with respect to Johnson & Johnson's efficacy, Dr. Fauci has already stated that with a booster you could well get closer to 90%. My understanding is that with AstraZeneca—with all the vaccines—you could add another booster to increase efficacy.

I thought I'd first like to comment on the relative efficacy of these. More importantly, however, I know Health Canada has to do its due diligence and approve these vaccines, but what is the likelihood that they're going to get approved and what will that mean in terms of time frames for distribution? I know Dr. Bogoch is on the Ontario task force on vaccines. What is your thinking in terms of how fast we'll be able to get vaccines out, if and when these other vaccines are approved?

I'll start with Dr. Bogoch, then maybe Dr. Attaran can also reply.

[Dr. Isaac Bogoch]

Those are great points and great questions.

I completely agree with your points about looking at the relative efficacy of these vaccines, because they're not direct head-to-head trials. Certainly, the Pfizer and the Moderna vaccines were studied in an era that was not the variant of concern era.

I also agree that the metrics we should be looking at don't necessarily have to land on protecting individuals from getting the infection, but on mitigating severity of illness, limiting hospitalizations and limiting deaths. These would be very successful metrics, and would certainly be helpful to navigate our way out of the mess we're in.

The newer technologies are also very useful, because they're, quite frankly, plug and play. You can update your vaccine to reflect circulating variants, and mass-produce them in a rapid manner relative to older vaccine technology that takes a lot longer, and has other issues we don't need to get into on this call.

As you point out, I do sit on the Ontario vaccine distribution task force, and there are publicly available documents for Ontario, as has been mentioned several times in various mainstream media outlets, of the program to rollout vaccination. Yes, there have been bumps along the road, but in general, when we have access to more vaccines, you will see much more widespread distribution.

It's not a fair comparison to say this is the same as influenza or measles vaccine distribution. There are true limitations based on the vaccines we have and cold chain issues. Having said that, all these plans involve: first, distribution through primary care; second, distribution at pharmacies; third, distribution through mass vaccine sites; fourth, distribution through public health clinics; fifth, distribution through community centres, where some communities that might not be as comfortable with the government or health care in Canada will feel more comfortable going; and sixth, mobile trucks and mobile units to help care for underhoused populations.

That is part of the plan. Operationalizing it is another thing, but that's the plan.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Dr. Attaran.

[Prof. Amir Attaran]

All the vaccines are good. It's not worth getting into a question of which is the best. They're all good enough to use.

The problem we have is getting more of them, and getting them quickly, particularly now that it's become geopolitical.

In 1976, there was a swine flu epidemic, and the United States shut down exports of vaccines to Canada. I'm hoping that with the next question I can get to the issue of manufacturing, and how we can stay safe from that.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I guess, on that matter, I can ask Dr. Attaran. You've talked about domestic capacity, and Mr. Gagnon has talked about compulsory licensing.

What production facilities do we have in Canada that could ramp up production faster than the companies that are presently making them?

[Prof. Amir Attaran]

There are companies in Canada, like NeuVax or Therapure that have biological molecule production facilities.

For the cell culture vaccines, which are Johnson & Johnson and AstraZeneca, it's just a question of having cell culture capacity.

If we can't do that in Canada, it is the industry norm to do that with contractors. We could simply hire one of the contractors, like Emergent, Lonza or Fujifilm, and ask them to lay on another batch. That would be a very simple negotiation.

The lawyer in me feels that, with the company that is the patent holder, you would essentially be asking them just to expand their contract manufacturing with an established contractor. We pay the freight, and we take the risk on the production, so why not?

[The Chair, Liberal, Ron McKinnon]

Thank you.

We now go to Mr. Thériault.

You may go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I want to thank all the witnesses for their participation.

Professor Gagnon, thank you for accepting the committee's invitation.

You mentioned something that we on the Standing Committee on Health noticed as well. At the beginning of the pandemic, all the experts and researchers told us about the extraordinary level of co-operation in the effort to find and develop a vaccine. The co-operation was certainly there.

The vaccine race has been on since August. Now that it's time to procure the vaccines, all that fine global co-operation and information sharing has gone out the window, and for good. We are nevertheless in the midst of a global pandemic, so borders are problematic. Until everyone on the planet is vaccinated, the problems caused by variants are not going anywhere.

You said this earlier, and you've talked about it in your articles: this way of doing things is disastrous. You said Canada had picked its side.

What could we do differently to achieve better public health results through a more unified position?

[Dr. Marc-André Gagnon]

Thank you for your question.

Take the AstraZeneca vaccine, for example. It was developed by the University of Oxford. Initially, the university had pledged to offer nonexclusive, royalty-free licences for its vaccine, but ultimately went back on its decision, opting to give AstraZeneca exclusive rights to the vaccine.

I read this week that, according to AstraZeneca's CEO, Pascal Soriot, the challenge is vaccinating as many people as possible, as quickly as possible, because the virus is spreading and mutating in parts of the world where people don't have access to vaccines. The vaccine protection people are acquiring now could drop, and even become obsolete as potential new variants emerge. However, when asked to make the patent royalty-free to provide access to the technology, as initially promised, so more manufacturers could use their facilities to produce the vaccine, AstraZeneca refused. It prefers to operate with licensing agreements.

It's important to understand something. The Pharmaceutical Accountability Foundation recently released a scorecard showing that AstraZeneca is currently the most ethical of the COVID-19 vaccine makers and is making every effort to offer accessible licences, but it's still extremely limited. Manufacturers are waiting even though their production lines are ready to go. Not only do they need to be given a compulsory licence and the formula, but they also need to have the knowledge and know-how. That's the only way they can help the effort. Under the current regime, companies seem quite reluctant to transfer that know-how.

What can we do, then? The thing to do would have been to ensure vaccine manufacturing capacity in Canada at the outset. The government made huge investments in Medicago to increase vaccine production capacity in Quebec. VIDO-InterVac, at the University of Saskatchewan, received considerable funding to boost its production capacity. Those are all positive steps, but Canada also needs to take a stand internationally and say that it wants to make the patents royalty-free. We are at war with a virus, so everyone should contribute to the war effort, not oppose initiatives to increase production capacity.

[Luc Thériault, Bloc, Montcalm, QC]

Isn't that the only way to overcome the shortage? Back in the fall, a number of pharmaceutical companies announced that they had effective vaccines, and similar announcements followed. Is it safe to say that companies rushed to take as many orders as they could but were unable to fulfill them? Now we are caught in this situation. As I see it, the only answer is to democratize vaccine production through licensed patents, so we can produce the vaccines ourselves in the middle term. Do you not agree?

We have to build our production capacity so we can alter vaccines in response to variants, if need be. Pharmaceutical companies will never be able to produce enough vaccines for the entire planet.

[Dr. Marc-André Gagnon]

I completely agree.

Early on, the efforts to find new vaccines were impressive. Many were developed. Now, pharmaceutical companies are signing confidential agreements with countries to deliver vaccines. We saw how quickly Pfizer-BioNTech ran into production issues—hence, this week's slowdown.

As for AstraZeneca, in Europe, the situation is much worse. Something of a trade war has erupted between Europe and the United Kingdom. If European countries want to prevent vaccine exports to the United Kingdom, under WTO rules, they have to prevent exports to Canada as well. We therefore find ourselves in a trade war where the companies are no longer able to fulfill their orders.

Countries adopted the strategy of lining up for pharmaceutical firms' vaccines and waiting for their doses, but now the doses aren't coming. What do they do now? It's late in the game to start coming up with new solutions.

Still, Canada has good vaccine production capacity—capacity that could be leveraged if royalty-free licences were offered on patents.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for being with us today.

Dr. Attaran, I would like to start with you. You stated last August that the National Research Council knows how to make vaccines. Its brilliant scientists were the world's first to fully deploy an adenovirus-vectored vaccine for rabies ahead of any pharmaceutical company. You have pointed out that the AstraZeneca vaccine is an adenovirus-vectored vaccine. Do you have any explanation for why Canada failed to negotiate the right to produce the AstraZeneca vaccine here in Canada? How serious an omission do you think that is?

[Prof. Amir Attaran]

I think it's a giant omission. As you know, there are many different vaccine technologies. You mentioned the adenovirus-based vaccines. There are two of those—AstraZeneca and Johnson & Johnson—and they're among the simplest to manufacture. We could manufacture them in Canada. It is a question of having a large vat in which you grow the cells that produce the vaccine. Then you purify the vaccine proteins, and then you formulate them and bottle them and all of that. We could do this in Canada. Contrary to the point of view that intellectual property is a big barrier here, AstraZeneca did license Brazil, Australia, India and several other countries to make its vaccine, and that has been done. Those countries are making the AstraZeneca vaccine. The intellectual property problems weren't that hard to solve. India is supplying it to its people as we speak. Brazil is rolling out the first doses this week. Australia, because it has so little COVID, is taking it more slowly.

This is something that Canada could do. The failure of the government to negotiate to produce the AstraZeneca vaccine back in the summer, as Brazil, India, Australia, Japan, Mexico and Argentina did, is a cardinal failure of this pandemic. Had we done so, we'd have something more right now.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Gagnon, I'd like to move to you.

In the roughest terms possible, what percentage of the research dollars that went into developing these vaccines in Canada was provided by the federal government?

[Dr. Marc-André Gagnon]

In terms of the development of vaccines in Canada, the main project we had in Canada was this partnership with the Chinese company. It didn't work. If you look at the global level—the contribution of different governments, basically—more than half of the contributions, in terms of investment, are first and foremost public investments. In Canada, the new challenger in terms of a vaccine is now with Medicago. It's still in clinical trials, but let's just say that it would be an interesting surprise if it could go through because we would have here a very significant production capacity for this.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'll pick up on my colleague Mr. Thériault's questions. You have said that what we are seeing is, for you, a bit of a catastrophe. You said, “You end up with a handful of companies that are developing their own vaccines, each by themselves, working in silos.” You said, “So then you have a product with a patent, so monopoly rights on the product. And then you end up with this vaccine nationalism of all countries basically doing a free market negotiation in terms of who can jump the queue in order to get faster access to the vaccines.”

You said, “In terms of the priorities of global public health, this is pure nonsense.”

I'm wondering if we got the model wrong. We have a global pandemic. We're talking in terms of war. I'm wondering if we brought a stick to a gunfight. Is using the private-sector model of private companies' monopolizing the patent and the intellectual property the best way to get vaccines out to the world? What would you suggest as a different model for that?

[Dr. Marc-André Gagnon]

This is an excellent question. First, there are alternatives, and this is something very important. We need to understand that more and more the type of research and development that is being done in pharmaceuticals is requiring us to go outside the patent model. Basically, patents work very well for certain research niches. For others, they don't work well, and in the case of pandemics like this one, it's very problematic because with the amount of power we're giving to drug companies, we then need to negotiate with these drug companies. Now we're negotiating maybe not with a gun to the head, but basically with a needle in the arm, and then we need to decide what we're going to do. We do not want to scare away the company by imposing some policies.

Let's just say that if the focus was on open science from the start, basically it would have been way more interesting.

I would like to add one thing. I agree with Dr. Attaran in terms of AstraZeneca, but AstraZeneca has been a bit different from other companies. It's the one that has been the most forward in doing these partnerships with other companies around the world. If you look at the different scoreboards with different companies, you see it's the only one that has been so proactive in this. With others, basically, it's all about preserving the expertise and knowledge they have.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Gagnon.

India and South Africa—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

I'd like to thank the witnesses. That brings our rounds of questions to an end. Thank you all for your time today and for sharing with us your expertise and your concern and care.

With that, we will suspend to bring in the next panel.

[The Chair, Liberal, Ron McKinnon]

We'll resume the meeting now.

Welcome, everyone, as we resume meeting number 16 of the House of Commons Standing Committee on Health. We are meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.

As we welcome our new panel, I would like to point out to the witnesses that they may speak in the official language of their choice. Interpretation services are available for the meeting. You have a choice at the bottom of your screen of “floor”, “English” or “French”.

With that, I will go through the list of witnesses. We have Dr. Joel Lexchin, medical doctor, appearing as an individual; from the Canadian Public Health Association, we have Mr. Ian Culbert, executive director; with the COVID-19 Immunity Task Force, we have Mr. Timothy Evans, executive director. From Medicago Incorporated, we have Ms. Nathalie Landry, executive vice-president, scientific and medical affairs; and we have Mr. Nicolas Petit, vice-president, commercial operations.

We'll start with Dr. Lexchin. Welcome, and please go ahead, sir. You have six minutes.

[Dr. Joel Lexchin, Medical Doctor, As an Individual]

Thank you very much for the opportunity to speak to the committee.

I am an emergency physician and have been one since 1982. I taught health policy at York University from 2001 to 2016, and I've been researching pharmaceutical policy for about 40 years.

I'm going to go into four different areas.

First of all, we have the situation that Canada found itself in with respect to vaccine production at the start of the pandemic. Back in 1989, we sold off Connaught Laboratories to a French company. Then, in 2005, ID Biomedical Corporation was sold to GlaxoSmithKline. Therefore, when the pandemic hit, we had no domestically owned independent production. We did have warnings that we might need it back with SARS in 2003 and then with H1N1 in 2009. The Naylor report after SARS recommended that we develop an independent vaccine strategy, but we never did.

When the pandemic hit, we were vulnerable when it comes to vaccines. In order to try to ensure that we were going to be able to get the necessary vaccines, in June of 2020 the National Research Council set up an 18-member COVID-19 vaccine task force charged with making recommendations about vaccine acquisition to the federal government. Initially, the conflicts of interest of those committee members were kept secret until there was a public outcry.

The task force was highly selective. There was no representation for indigenous or Black people, the elderly, women or people with disabilities. Both the chair and the co-chair had significant conflicts of interest. Whether or not those conflicts of interest affected the recommendations they made to the government is unknown, because the exact nature of the recommendations is not public.

Other countries have handled the situation much differently. In the notes I submitted, you can see that Australia did things in a much different fashion.

We're now faced with the delays in the delivery of the Pfizer vaccine and possibly others. The delays in different countries are different. That might be due to the terms of the contracts that have been negotiated, but we don't know, because the contracts are kept secret. Also, we don't know anything about the price that Canada is paying versus the price in other countries. What are the guarantees about vaccine delivery and are there penalties for companies if they can't meet delivery schedules?

Finally, I want to talk about Canada's position on ensuring vaccine availability and affordability in low- and middle-income countries. Canada is one of the largest donors to COVAX. In July 2021, Prime Minister Trudeau signed a letter, along with other global leaders, which said, among other things, “We”—the global community—“cannot allow access to vaccines to increase inequalities within or between countries—whether low-, middle- or high-income.”

At the same time, Canada didn't support—and still hasn't supported—the WHO COVID-19 technology access pool. It hasn't supported the call by India and South Africa at the World Trade Organization for a temporary suspension of patents and other intellectual property. It has not publicly demanded that companies making vaccines ensure that they are available at production costs, and it has not said when it's going to donate excess vaccines to low- and middle-income countries.

I have four recommendations to make to the committee.

One, Canada needs to develop a national vaccine strategy that will consist of a strong and enduring financial commitment to publicly funded and publicly run vaccine research.

Two, we need a domestic, publicly owned vaccine manufacturing facility, so that in the future we can avoid the situation of privately owned Canadian companies being sold to foreign interests.

Three, Canada needs to make public the terms under which it granted money for COVID vaccine research and the terms of the contracts that it has signed with companies for vaccines.

Finally, Canada needs to publicly outline a detailed strategy about how it will contribute to ensuring that vaccine nationalism is avoided so that low- and middle-income countries can access vaccines in a timely manner in line with their needs.

Thank you very much.