Health Committee on Feb. 22nd, 2021

[Dr. Alan Bernstein]

Yes, I've been quoted in an interview in the newspapers that I think mixing and matching has several advantages. One is for the viral vector vaccines like the AstraZeneca Oxford vaccine. The second time you come in with the second shot, the host will have already, perhaps, mounted an immuno-response against the vector itself, and so you'll have diminished effectiveness of the vector or the vaccine the second time around, whereas, if you only give it once and then come in, for example, with the RNA vaccine, you're combining the best of both worlds. That's one reason.

The other reason is that there's evidence that the RNA vaccines are particularly good at mounting one arm of our immune system, making antibodies, whereas the viral vector vaccines are particularly good at activating another arm of our immune system, which is the so-called cellular arm of our immune system. By combining the two, you get, again, the best of both worlds.

The third reason, of course, is that, in terms of vaccine availability, if we find that we have a lot of one and not the other, that's another argument for doing both.

I think the bottom line is that we won't know until we do a trial to really measure the effectiveness of that mix-and-match strategy. That trial's begun in the U.K. Here in Canada, my recommendation is that we should also consider doing such a trial as well, perhaps in partnership with the British.

[Luc Thériault, Bloc, Montcalm, QC]

Do you think pharmaceutical companies would be very keen on this idea, given their responsibility for the efficacy and adverse effects of vaccines?

How can this responsibility be determined if two vaccines are mixed together?

They may need to be convinced of the scientific advantage of this.

[Dr. Alan Bernstein]

Absolutely. The end point for these trials would not be whether they're protective, which would take a long time and a lot of people in the trials. The end point could simply be how well the mix-and-match strategy elicits a very robust immuno-response relative to not using a mix-and-match strategy; that is, going in with two doses of the RNA vaccines or two doses of the viral vector vaccines. Those are quick trials that could be done over a period of about a month or so to assess this. I think there are some—

[Luc Thériault, Bloc, Montcalm, QC]

Agreed, but to whom should the adverse effect that would occur in the case of a combination be attributed?

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

The problem remains unsolved, even if it is not necessarily a scientific one.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Thank you.

We will go now to Mr. Davies.

Mr. Davies, go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

First of all, Dr. Bernstein, thank you for your service on the vaccine task force.

Dr. Bernstein, I know that the analogous organization or committee at the World Health Organization offers open access to its meetings. In the U.S., the vaccines and related biological products advisory committee publishes its agenda. It publishes its conclusions, and the entire meetings that they conduct are webcast on YouTube for anyone to see.

Is there anything different about the manner in which Canada's vaccine task force conducts its meetings that would prevent that kind of transparency?

[Dr. Alan Bernstein]

Mr. Chair, I'd have to look at exactly what those other two committees do to give you a complete answer.

I would say that, when the Canadian vaccine task force got started, we were just swamped with the need to identify, as quickly as possible, those vaccine candidates that would yield the very best vaccines for Canadians. Indeed, here we are now, seven months later. I think all of us feel very proud of the fact that the six candidates we identified, the international ones, are exactly the six that everyone in the world now wants. We did our due diligence, I think, absolutely correctly. That was our number one priority.

I think the second priority was, as you said, transparency or making things more open. I certainly think there would be room for us to do that. Part of the issue, of course, was that we were providing advice to ministers, which, as you know, is confidential in the parliamentary system. Second, there are some industry issues. Every company that came in front of us, both Canadian and international, required that we all sign confidentiality agreements with them. Indeed, there were confidential issues from the companies' points of view that we could not release, so there are some issues.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm going to ask you a question I asked a previous panel member. Last Thursday, the co-chair of the federal vaccine task force, Mark Lievonen, told the industry committee that domestically producing and supplying a COVID-19 vaccine was never possible before the end of 2021. Those were his exact words.

We all know that the Prime Minister issued a press release on August 31 saying that the National Research Council would be producing 250,000 doses per month in November and millions by the end of 2020. I'm just trying to get a straight answer from someone. Did Canada have the capacity to produce vaccines in 2020 or didn't we?

[Dr. Alan Bernstein]

Thank you for the question. I'm a fundamental scientist, not a vaccine manufacturer, so you'll understand when I say that it's really outside my own area of expertise.

When we discussed that issue on the vaccine task force, I think the issues that came up pretty quickly were around how complicated it is to make vaccines. These are not like the N95 masks that we just heard about, for example. These are biologics that are being injected into healthy people.

It's very sophisticated science and these are very sophisticated public health issues, so the production and the manufacture of all these vaccines is very complicated. Indeed, if you look at the holdup with Pfizer—which is a very experienced vaccine manufacturer—in scaling up their manufacturing, I think you get a sense of how complicated it is to actually make vaccines.

[Don Davies, NDP, Vancouver Kingsway, BC]

With respect, Dr. Bernstein, I have limited time. The question is about capacity, not about complexity.

On November 26, you noted in an article in the National Post that the federal government should consider working with AstraZeneca to produce the vaccine at the NRC's Royalmount facility in Montreal. You were quoted as saying, “250,000 doses a month would make a big difference for us. You know, that's probably the number of frontline health care workers.” Why did that not happen in Canada?

[Dr. Alan Bernstein]

You'd have to ask the NRC about that.

I think the issue is that at that point, the NRC had ended its partnership with CanSino, which is a viral vector vaccine along the same lines as the AstraZeneca vaccine. I think they were in discussions with AstraZeneca. I think you heard that from the president of the NRC. At that point, we were also simultaneously in discussion with Novavax, which ultimately has led to a successful completion. I think they were looking around for a partner that would come in and work with them on that.

What I meant in saying that is that if we had domestic capacity, of course we could scale up and rapidly produce vaccines here.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you confirm whether the vaccine task force recommended ordering vaccines based on weekly, monthly or quarterly delivery targets?

[Dr. Alan Bernstein]

We did not. Our primary concern was the quality of the science, whether the company and its partners were capable of doing the trials, and whether they were capable of scaling up. The procurement issues were all handled by the department of procurement,Minister Anand's group.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Do I have time, Mr. Chair?

[The Chair, Liberal, Ron McKinnon]

You have 20 seconds.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll try to get this out.

A senior government official recently told the press that the federal government's plans to commence a mass vaccination campaign in April were thrown off when Health Canada approved the Pfizer and Moderna vaccines earlier than expected. According to that official, Canada's contracts with the two companies, which have not been made public, focused on large-scale shipments after April 1 because the federal government believed no large supplies would be available before then.

Can you confirm that the vaccine task force advised the government to structure supply agreements based on that assumption?

[Dr. Alan Bernstein]

We did not get into any of the details of the procurement arrangements. We simply recommended to ministers which vaccines should be purchased and which ones should go to the NRC for IRAP, as I indicated earlier.

I think all of us—not just in Canada, but in the world—were surprised at how quickly we were able to develop vaccines. It was less than a year. It is a remarkable result, but I don't know what was in those procurement agreements.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Committee, that wraps up round one. We don't have very much time left, but I'm going to propose that we sneak in a one-minute round with everybody. In that case, I would suggest you keep your questions to 30 seconds and allow 30 seconds to respond.

On that understanding, for the Conservatives, I think we have Mr. d'Entremont next. Please go ahead, sir.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you.

We had some pretty disappointing testimony last Friday about data and exactly how many Canadians need to be vaccinated before we have herd immunity, so maybe this is a question for Dr. Sharma.

Do you have any modelling that would actually tell Canadians how many people need to be vaccinated to get out of this pandemic?

[Dr. Supriya Sharma]

In general, herd immunity is the number of people who need to have immunity to protect people who are within the herd who do not have immunity. Whether you get it through having had the disease or being vaccinated, it's that protective sort of effect.

Herd immunity for a virus can be anywhere from 50% to 90% of people who need to be vaccinated. Certainly with respect to COVID-19 and the SARS-CoV-2 virus, when we were first looking at it, I think we were looking at estimates of around 60% to 70% that we would require being vaccinated. Now with the emergence of variants and because they are more transmissible, I think a lot of people are adjusting those numbers up towards more like 85%, or even potentially 90%, coverage to achieve herd immunity. Certainly it's a moving target, because as we know, the virus and its transmissibility, and how contagious it is, is changing.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We'll go now to Dr. Powlowski, please, for one minute.

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

There's some very interesting news coming out of Israel from the Israeli health ministry and Pfizer, which seems to have very thorough reporting of data. They're saying the Pfizer vaccine reduces asymptomatic cases by 90%. If I got that right, that's really significant, and they seem to have the same interpretation. This means a lot, because previously we thought you could get the vaccine but maybe you still could get an asymptomatic infection and could transmit it on.

If true, and I don't know whether you think the data is adequate enough, it would seem to have immense implications for a lot of different policy areas, from whether people who worked in chronic care homes could continue to do so without being vaccinated to opening our borders to people who have been vaccinated.

How good do you think that data is, and should we make policy decisions based on it?

The question is to Dr. Sharma or Dr. Bernstein, whoever wants it.