Health Committee on Feb. 19th, 2021

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

If anyone wishes to answer, please do so. I see no one, so we will move on.

We go now to Dr. Powlowski.

Dr. Powlowski, please go ahead for five minutes.

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

I have a question about mixing and matching vaccines.

The head of NACI brought this up, but certainly there is an interest in perhaps combining vaccines; doing so might improve their coverage. I think she said that in animal models they tried AstraZeneca followed by one of the messenger RNAs and that doing so improved its efficiency. I think she did mention studies being done in England.

Would you know whether such studies are being contemplated in Canada, and would such studies get any financial support from the government? I doubt it's in the vaccine company's interest to try mixing and matching, but it would certainly be in the public interest if we could combine them.

[Kimberly Elmslie]

I don't know if Dr. Poliquin would like to comment on that, but as you said, these studies are going on in the U.K. and are looking at combinations of Pfizer and AstraZeneca as a two-dose interchangeable approach to vaccination. From that perspective, we are awaiting the results of the U.K. study.

[Dr. Guillaume Poliquin]

Just to build on that, the vaccine science is certainly an area of ongoing focus and interest in terms of evaluations within animal models, but more tellingly, some of these studies will need to occur in human clinical trials. As we continue to learn more about vaccine variants and the interplay they represent, additional studies will be contemplated.

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

If you look at the existing phase three trials, I think those were done at the expense of the vaccine producers.

As I said, it doesn't seem as though mixing and matching is necessarily in the financial interests of the vaccine companies. Who will provide the financing for those clinical trials to see whether this adds efficacy to the vaccines?

[Dr. Guillaume Poliquin]

There's a range of funding mechanisms to tackle these types of studies, including pre-clinical studies that can be done within laboratories as well as human clinical trials that could be funded through a number of different mechanisms, including the Canadian Institutes of Health Research. Specific funding questions would be dependent on the study design.

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

I'm not sure how much PHAC will take this issue on, but I think that certainly there have been some recent studies that have suggested that Bamlanivimab is effective when used early. As I recall the numbers from The New England Journal of Medicine study, it decreased visits to the emergency room and hospitalizations from 4.5% to 1.5%, I believe, if given early, and in high-risk people, from 14% to 4.5%.

Yet in talking to clinicians, they're certainly having trouble accessing these forms of medication. It would certainly seem like potentially a second front on the fight against COVID if people who were at high risk once they got the disease.... There actually have been studies showing in terms of people in chronic care homes—I think you're probably familiar with this—that when it's given prophylactically to people who are negative for COVID so far, it reduces their risk of getting the disease. It would seem that this would have some usefulness in institutions or places where there's a high risk of contracting the disease and where the people themselves are at high risk if they get sick, and/or treating people who are at a high risk as soon as they get sick.

Have there been any efforts by the Public Health Agency of Canada to assist the provinces, which obviously have the primary responsibility, and to get them these forms of treatment earlier? Or do you still think this is too speculative?

[Bersabel Ephrem]

Mr. Chair, I can start, and I will give it to Mr. Szumski to finalize it.

The Government of Canada has been able to procure about 17,000 doses of Bamlanivimab, and they have been distributed across the jurisdictions for their use, according to their clinical guidance. There have also been additional efforts to bring together Eli Lilly and the provinces and territories to get more evidence to be able to see where and how it could be used.

That's what we have done at this point. I don't know if there is anything else to add.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

We will go back to the Conservatives now.

Ms. Rempel Garner, please go ahead.

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

Thank you.

When Dr. Njoo was talking about a potential one-dose directive, he said, “Everyone can look at the evidence...obviously based on local and the provincial context...[and]...make their own respective decisions.”

When the modelling was released today on the potential spread of the variants, did it factor into provinces choosing to use one dose of either the Pfizer or Moderna vaccines and efficacy rates against the variants?

[Dr. Guillaume Poliquin]

Just to be clear, the modelling that was released today was looking at epidemic curves and the potential interplay of the addition of variants to that. They were not specifically looking at the impact of different vaccine rollouts.

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

Okay, so vaccine rollouts weren't considered in the modelling released today?

[Dr. Guillaume Poliquin]

Different approaches to the vaccine rollout were not considered in the models today. It's specifically looking at one dose versus two doses.

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

Would PHAC be issuing to the provinces...? When they're saying that provinces would be able to make their own decisions, is PHAC going to be providing data and a recommendation to the provinces in regard to one dose versus two in the context of the efficacy against the variants?

[Kimberly Elmslie]

That is always part of the work we do with provinces and territories. What we will do is that we will bring the analysis that we receive through NACI. We will bring the analysis that we do ourselves—

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

Thank you.

Has that analysis been completed yet?

[Kimberly Elmslie]

That analysis will be completed as we get more data and as NACI receives more data next week from Public Health England and from other sources, so it's premature to—

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

So saying that provinces would be able to make this decision was premature...?

[Kimberly Elmslie]

No. I'm saying it's premature to bring forward the data, because we are awaiting it from another jurisdiction.

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

Okay. There's no data yet is what you're saying.

[Kimberly Elmslie]

There are data from some trials. We're waiting for NACI to consider it and synthesize it as they do for us as part of their mandate.

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

I'm going back to a different line of questions. Which part of PHAC provided the advice to the government to undertake the quarantine hotel measure as opposed to expanding the Calgary airport border pilot program across the country as a better way to control the variants?

[Cindy Evans]

Mr. Chair, maybe I could just speak in general to the implementation of our border measures.

In terms of trying to bring the pandemic under control, we're wanting to have public health measures that address preventing community spread as well as the importation of cases. Canada continues—

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

I'm looking specifically to comparative models. What data shows that the model being used at the Calgary airport is less effective than the quarantine hotel method?

Anybody? Is there any data on that at all?

Was that a political decision or a decision made from PHAC? Did PHAC advise the government, or did the government advise PHAC on the quarantine hotels?

Did PHAC tell the government that we should be doing quarantine hotels, and if so, what was the data used?

[Kimberly Elmslie]

Mr. Chair, I think that I may have indicated earlier that what we would like to do is bring that data back to the committee and we would undertake to do that.