Evidence of meeting #20 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was nrc.
A recording is available from Parliament.
Professor, Université Laval, As an Individual
This is just a matter of opinion. There was evidence of conflicts of interest, at least from my perspective, including that one member sold the equipment for $20 million, while being on the task force to the federal government for doing fill and finish.
I think this was information that was, unfortunately, not reviewed, in my view, by an independent ethics committee to assess conflict of interest.
Professor, Université Laval, As an Individual
Absolutely, they should have been reviewed before starting the work with this task force, like for every other....
I do conflict of interest statements monthly for the WHO. They are due before we open the line. If they are not done, we cannot participate.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
I know the WHO has a video link allowing anybody to tune in. The U.S., as well, webcasts its meeting on YouTube.
Should Canada do the same?
Professor, Université Laval, As an Individual
The answer is yes, we should. Media was also present for the meeting at the WHO, which could also be done here.
Liberal
The Chair Liberal Ron McKinnon
Thank you all.
We're a little over time on this panel. I thank all the witnesses for your time and your very helpful testimony today.
With that, we will suspend and bring in the next panel.
Liberal
The Chair Liberal Ron McKinnon
This meeting is now resumed.
Welcome back to meeting number 20 of the House of Commons Standing Committee on Health, where we are meeting to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.
On the panel today, as an individual, we have Dr. Kashif Pirzada, emergency physician and assistant clinical professor at McMaster University. For the Canadian Institute for Advanced Research, we have Dr. Alan Bernstein, president and chief executive officer. From the Department of Health we have Dr. Supriya Sharma, chief medical officer.
We will start with statements from our witnesses.
We will start with Dr. Pirzada. You have six minutes, please.
Dr. Kashif Pirzada Emergency Physician and Assistant Clinical Professor, McMaster University, As an Individual
Thank you, Mr. Chair and members of the committee, for taking the time to listen to our comments today.
I am pleased to present on behalf of the Critical Drugs Coalition, a grassroots group of frontline physicians, pharmacists and academics. We do not seek nor receive any kind of funding from any entity—public or private. We want to provide recommendations for how the federal government can further the goals of mass vaccination and improve the overall security of Canadian drug and vaccine supplies.
As an emergency physician in Toronto, I've seen many people unfortunately pass away from COVID. I was also a key member of Conquer COVID-19, a community group that helped source PPE at the start of the crisis, and Masks4Canada, which successfully advocated for mask-wearing bylaws across the country.
My attitude, and that of many of my colleagues, is that we have a mess here, but let's see what we can do to fix it and save lives. That's how we approach our patients and that's how we should approach this crisis.
Drug and vaccine shortages are not a new issue. They've only been made worse now in this pandemic. It has been an ongoing health security issue for over a decade now in Canada.
In August 2020, we sent an open letter to the Prime Minister's Office detailing our concerns and highlighting some realistic and cost-effective solutions to include domestic manufacturing. The letter is co-signed by the Canadian Medical Association, the Ontario Medical Association and many other national bodies.
Our current vaccine shortage shares a common route with drug shortages: the lack of dependable and scalable domestic manufacturing. We have the following three recommendations.
One, Canada needs local production of drugs and vaccines. mRNA is a new technology that has incredible potency in fighting COVID-19, cancers and possibly other viruses. When I was a lab student 20 years ago, this stuff was science fiction, and the advances made are just incredible. With virus variants, we all need periodic boosters, possibly for years, as we do with the flu. We have the expertise, from the testimony we heard earlier, from companies such as Acuitas and Providence Therapeutics that can make it here. It is also the promise of second-generation genetic vaccines that can induce longer immunity, and these companies are working on it, the ones that we spoke to.
It's great that federal funding is flowing to these companies now, but this support needs to continue. This is a nascent industry, and the technology underlying it is going to revolutionize pharmaceuticals, cancer care and agriculture. It's crucial that we get on board now. It's great that it's also in the provinces that are losing other traditional industries. These are thousands of high-quality jobs. Therefore, it's a win-win for the country.
Our second point is that science coordination and communication needs to improve in this country. We are losing a head-to-head comparison with the U.K., the U.S., Israel and many other countries. The U.K. was able to mobilize a unified effort across industry, academia and government and had a cabinet-level post of vaccine minister.
I'll give you an example just from my personal history. I, along with half of my U of T class in 2003, was quarantined during SARS after inadvertent exposures. Many of us survivors from that time have been trying to get attention on issues such as PPE, drugs and vaccines, but there's no one to talk to, no network to access and no way to warn the government about what we knew was coming back in 2020. We need to involve grassroots frontline providers, scientists and industry leaders in a regular network of advisory groups like the U.K. does. Get the meetings online, make them public, get the deliberations public and that's how you share information freely.
Our third point is that we have some grave concerns from the front lines on the vaccine scale-up and rollout. The rollout so far to health care workers has been fairly chaotic. Many rural providers have not gotten their doses. If the government can't get this right with a smaller population like that, what are the chances it's going to work for 37 million Canadians?
We should keep things simple, as the U.K. has done. Avoid overly complex criteria and tell the public about plans. Be transparent. Who is getting it, when and where? Focus on the most important thing of all, which is getting vaccines into people's arms as quickly as possible.
Another point we've discovered is that community providers have not been engaged in the vaccine rollout so far. Family physicians and pharmacists can deliver millions of doses a week, but they're not involved. They have access to and good insight into vulnerable patients and communities, unlike others.
Another frontline insight is that some have been able to squeeze extra half doses out the Moderna vials and combine them into a single dose, but they are being discarded right now because there's no approval for unorthodox procedures like that. However, in a crisis such this, we should look at any option.
Our final point on the vaccine rollout is that we should seriously consider giving a single dose of the vaccine to as many Canadians as possible. Just today, we have seen seven schools in B.C. closed because of outbreaks and likely airborne spread of the South African variant, which is widespread in the city of Toronto now, in Mississauga. Variants are spreading quickly: in my own hospital log, a dozen last week and five more today. They're more contagious and likely airborne.
We should take pride that we've vaccinated many long-term care patients. However, we are discounting the long-term consequences of even mild COVID-19 infections on younger populations. We should not assume that if they only get mild or moderate illness they're fine. In fact, 15% of them will get what's called “long COVID syndrome”. They'll have memory issues, chronic pain and chronic fatigue, and this will last possibly for years. They won't be able to go to school or work in their jobs. Normally healthy, able-bodied people will have their quality of life ruined and forced onto long-term disability at extreme cost to themselves and their families, and this might even affect children. Imagine if 15% of our children couldn't taste anything or had chronic pain and were unable to go to school.
In summary, as frontline workers battling this pandemic, we recommend that we build vaccine and drug capacity in Canada, we improve communication with frontline workers, decision-makers, and finally we ensure we have an effective vaccine rollout and protect as many as Canadians as quickly as possible with the first dose of the vaccine.
Thank you very much.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We go now to the Canadian Institute for Advanced Research, Dr. Alan Bernstein, president and chief executive officer.
Please go ahead, Dr. Bernstein, for six minutes.
Dr. Alan Bernstein President and Chief Executive Officer, CIFAR
Thank you, Mr. Chair.
Thank you to all members of the committee for your time and interest in clearly what's a very important matter.
My name is Alan Bernstein. I am president and CEO of CIFAR. We are a Canadian-based global research organization. I believe I have been called as a witness here today because I also serve with honour as a volunteer member of the federal vaccine task force.
As you know, the vaccine task force was formed in June of last year to advise the government on the very best strategy to secure a safe and effective COVID-19 vaccine for Canadians as quickly as possible. In doing so, we were also tasked to look at both domestic and international candidates and to look at the state of biomanufacturing capacity in the country.
The vaccine task force is made up of a distinguished group of immunologists, vaccinologists, vaccine developers, biomanufacturers, ethicists and lawyers. We serve as volunteers, providing our very best possible advice in a timely manner in a very changing and uncertain environment. You will recall there was no vaccine last summer, nor was it clear whether there would ever be a vaccine. I want to stress that. Most vaccine journeys end in failure. We were trying to cover our bases with the vaccines we recommended to government.
Our very first meeting was on June 16. We've now met at least 40 times as a task force, for a total of over 125 hours, plus roughly an equal amount of time devoted to studying the proposals that were put in front of us. Let me stress one thing: our primary objective and the charge we were given by ministers was to recommend those vaccine candidates that were most likely to lead to safe and effective vaccines for Canadians as soon as possible. At our first meeting we quickly decided not to put all our eggs in one basket, to put many shots on goal, which you have to take if you want to win a game. We also decided that, given the uncertainties and the seriousness of the situation, we would hedge our bets by recommending at least two vaccine candidates for each one of the three main scientific platforms that are available: RNA vaccines, a new platform; viral vectors; and protein subunits. Such a diverse portfolio of candidates might also reflect the needs of different target groups in any immunization strategy that government might decide to implement.
We were also very cognizant of two factors. First, the majority of vaccine development journeys end in failure. Second, the successful development of a vaccine, through trials to regulatory approval to scaled-up capacity to rollout, is best characterized as a voyage in very rough seas. We therefore felt that Canada needed an appropriately diverse mix of science platforms and firms within the portfolio of candidates that we would ultimately recommend to ministers, even if that meant recommending that Canada purchase more vaccine doses than we might need.
Although ministers made clear that the first priority was to recommend the very best vaccine candidates, some special attention should be paid to domestic proposals. Twenty-four Canadian proposals were carefully examined and three were recommended: Medicago, Variation Biotechnologies and Precision Nanosystems. These three companies are receiving significant government support for vaccine development through the strategic innovation fund.
Some other domestic candidates showed promise, but for a variety of reasons the vaccine task force felt they were at too early a stage for significant investment at the time we looked at them. Therefore, we recommended that six of these projects be referred to the National Research Council for funding through IRAP, the industrial research assistance program. The six projects that received funding in that way were Biodextris, Entos, Glycovax, Inovio, Providence Therapeutics and IMV. In addition, several companies, such as Entos and Providence, received significant additional funding through grants from the Canadian Institutes of Health Research and the NGen fund respectively.
Thank you, Mr. Chair.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We go now to the Department of Health and Dr. Supriya Sharma, chief medical adviser.
Please go ahead for six minutes.
Dr. Supriya Sharma Chief Medical Advisor, Department of Health
Good afternoon, Mr. Chair, and thank you for the opportunity to appear before the committee today.
I appreciate this opportunity to highlight how Health Canada has been using agile regulatory processes to expedite the access to COVID-19 vaccines while maintaining high standards for safety, efficacy and quality.
My name is Dr. Supriya Sharma, and I am the chief medical adviser at Health Canada and also the senior medical adviser at Health Canada's health products and food branch.
I want to begin by saying that, since the beginning of the pandemic, our fundamental priority has been to ensure that nimble and timely processes are in place to review applications for clinical trials as well as submissions for authorizing COVID-19 treatments and vaccines.
In particular, we recognize the vital importance of vaccines in Canada’s pandemic response and our fight against COVID-19. Since the start of the pandemic, Health Canada has worked closely with other departments and the Vaccine Task Force on vaccines against COVID-19—
Liberal
The Chair Liberal Ron McKinnon
Pardon me, Dr. Sharma, we seem to be having a problem with the English translation. The French is coming through very well on the English channel, but the English translation is very, very weak. I wonder if we could have a look at that.
Please continue.
Chief Medical Advisor, Department of Health
Since the start of the pandemic, Health Canada has worked closely with other departments and the Vaccine Task Force to develop and implement Canada's vaccine strategy. Early on, we recognized the need to facilitate clinical trials of drugs for COVID-19, given that no treatments or vaccines were available for this new virus.
In May 2020, Canada’s Minister of Health approved an interim order to facilitate clinical trials for COVID-19 products. Among its benefits, the Interim Order reduces the administrative burden for sponsors without compromising the safety of participants, and makes it easier to set up trials across Canada.
In September 2020, the Minister of Health introduced another interim order to expedite the review of treatments and vaccines for COVID-19, while maintaining a high level of scientific scrutiny.
This interim order allows Health Canada to approve a new vaccine based on available evidence with more agile administrative and application requirements and to apply terms and conditions to require the manufacturer to continue providing information on the safety, efficacy and quality of the vaccine once marketed; and permits the Public Health Agency of Canada to arrange for the importation of promising COVID-19 drugs into Canadian facilities prior to approval in Canada.
The interim order also allows for rolling reviews, which lets a vaccine manufacturer submit its request for authorization before it has completed all the clinical trials. This means that it can submit required data as they become available.
Additionally, we have a strong post-market safety surveillance system to monitor the safety of COVID-19 vaccines. Once a vaccine is on the market, Health Canada and the Public Health Agency of Canada monitor for any adverse events after immunization in collaboration with the provinces and territories and the manufacturer. The interim order provides the authority to impose terms and conditions on any authorization at any time, such as conducting additional assessments of safety information.
All of Health Canada's regulatory decisions are independent and based solely on science and evidence.
So far, 10 submissions have been received under the interim order—including four treatments and six vaccines. Two vaccines and one treatment have been authorized, while the others remain under review.
Another key step that we have taken to ensure timely and thorough approvals is hiring additional scientists and establishing dedicated review teams for COVID-19 vaccines, in order to ensure consistency in reviews. These review teams, comprised of experienced regulatory and scientific experts, focus solely on COVID-19 work, and have been working around the clock on the scientific reviews of submissions.
Health Canada reviewers are scientists and physicians with many years of experience reviewing vaccines, and with expertise in different domains including, but not limited to, clinical medicine, toxicology and pharmacology, biochemistry, virology, immunology, microbiology, and other scientific disciplines relevant to the development, testing, manufacture and quality control of vaccines.
Furthermore, as soon as there was information that vaccines were going to be developed, our department worked closely with other international regulators and the World Health Organization to collaborate on the regulatory requirements for COVID-19 vaccines and to make the regulatory processes as efficient as possible.
These partnerships allow us to share information, support scientific collaboration and align regulatory approaches and requirements for vaccines, while still making independent decisions for Canadians.
Together, these measures have allowed Health Canada to authorize several clinical trials in Canada for COVID-19 vaccines, as well as the two vaccines, Pfizer-BioNTech and Moderna, that are already being administered to Canadians.
Our response to the pandemic is being guided by the latest science and research. We also continue to monitor the emerging viral variants closely, and work with manufacturers and international regulators to assess the impact of the new variants on vaccine efficacy and provide guidance to manufacturers.
As part of our commitment to openness and transparency, Health Canada has published detailed information about the authorized COVID-19 vaccines on the department's new COVID-19 vaccines and treatments portal. Health Canada and the Public Health Agency of Canada also provide weekly updates on reported adverse events following immunization.
Canadians can feel confident that the review process for vaccines is rigorous and that we have a strong monitoring system in place.
Once again, thank you for this opportunity to speak with the committee today. I'd be happy to answer any follow-up questions you may have regarding Health Canada's vaccine approvals process.
Thank you.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We'll start our rounds of questions now with Ms. Rempel Garner, please, for six minutes.
Go ahead.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Dr. Pirzada, thank you so much for taking time to be here today and for your service in our community.
You might not realize this, but you've had an impact on me and my role as a vice-chair of this committee since I was appointed last fall. Since the pandemic started, I've always been of the opinion that in order to reduce the larger societal impacts of lockdown, we should be looking at ways to undertake more targeted isolation measures supported by rapid testing, so we can prevent the spread of COVID but also reduce the harm of domestic violence, suicide rates, mental health, surgeries being cancelled and all the stuff I'm sure you're seeing.
You wrote an article in the fall, talking about the need to have rapid test deployment, and here we are, six months later, on track to have well under 10% vaccinated by the end of March. Do you think it's time we had a federal strategy on rapid testing deployment?
Emergency Physician and Assistant Clinical Professor, McMaster University, As an Individual
Definitely. This is an underused technology. Slovakia and other countries have used it to lower their burden. Baby steps have started to be taken in Ontario on rapid testing: I think we bought 20 million of these tests, but we need 10 million to 20 million of them every week. If we can get everyone testing quickly two or three times a week, we can really bring down the numbers and make things like opening schools a lot safer, so I think this should definitely be a priority for the government.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
I'm half Slovak, and I met with their ambassador on it. I know it's been going very well there.
I've heard everything from the federal government, from “Rapid testing isn't a panacea; it won't work,” to “It's not our responsibility. We bought the things for the provincial government. They're not deployed.”
Canadians are starting to get tired of the finger pointing across jurisdictions. Given our jurisdictional boundaries, how could the federal government take a more active role or provide more value-add in deploying a test like this, especially knowing that vaccinating everyone is probably another six months away at very best?
Emergency Physician and Assistant Clinical Professor, McMaster University, As an Individual
I would say to license manufacturing here. There's a great company in Halifax, Sona Nanotech, that makes them. We can make them here. We can license them from Abbott as well. We need tens of millions of these tests every month. We need lots of them. Get them into schools. Get them into the workplaces that keep having outbreaks. We know that they will work with the variants as well. It's a great strategy, if we can get them out there.
Approve more of them. There are some tests that have been approved in Europe that haven't been approved here yet. Just get them out there and get them to work.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
I listened to the chief public health officer on Friday. She made a statement that it was unlikely that Canadians were all going to be vaccinated this year. She also presented some projections on the spread of the variant. On Friday, we had officials from PHAC here talking about what the modelling included and didn't include. I was really surprised that they weren't able to speak to assumptions around rapid testing and vaccinations in future models.
Do you think if we had a national strategy for rapid testing it could help us prevent the spread of the variant?
Emergency Physician and Assistant Clinical Professor, McMaster University, As an Individual
I think it's something to be considered. The variant is way more contagious; there is airborne spread. Just look at the building outbreak in Mississauga. It did not happen from people in close contact with each other. They were in vestibules, maybe in elevators. Everything needs to be done to stop the spread of that.
It's something that would really help, I think, along with other things like fixing ventilation and getting people to wear improved masks as well. Those are all important things.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
That's great.
If you want to table some further recommendations on that to this committee, we would love to have them.
From some of your writings and your testimony here today, and frankly as a policy-maker with people calling my office and asking when this is going to end, I think the general theme of the last year and half has been that there is a lot of inertia within our bureaucracy and not a lot of direct input either from people who are dealing with this on a daily basis through lived experience or from frontline medical workers.
If there were three things or more that the federal government could do today to have more input from folks like you to overcome this inertia, what would those be?
Emergency Physician and Assistant Clinical Professor, McMaster University, As an Individual
I think one would be to get us here more often. There are lots of people like me out there who have a lot of good observations. The medical community really wants to talk to you guys and give you our viewpoints.
The second thing right now is just to tell the public to really look out for airborne spread of this virus. N-95s are easy to find now. A lot of Canadian companies are making them. We have a great list online; you can search for it.
The third thing I would say is to really listen to the science and try to get ahead of this. Europe has given us a great head start. Just follow whatever they're doing that is working. Really think about single-dose vaccinations as the U.K. is doing. I think they are going to be the first ones out of this.