Health Committee on Feb. 26th, 2021

[The Chair, Liberal, Ron McKinnon]

I now call this meeting to order.

Welcome, everyone, to meeting number 21 of the House of Commons Standing Committee on Health. We're meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.

I would like to remind everyone that you have the right to participate in these proceedings in the official language of your choice. In the event of difficulty hearing the translation, please bring it to our attention as soon as possible so that the matter can be resolved.

I'd now like to welcome the witnesses.

Appearing as an individual is Dr. Joanne Langley, professor of pediatrics and community health and epidemiology. Appearing with Dr. Langley is Mr. Roger Scott-Douglas, secretary of the COVID-19 Vaccine Task Force. He will not make a presentation but will assist Dr. Langley in answering questions. Also appearing, in this case as an individual, is Dr. Andrew Morris, professor of infectious diseases. From the Canadian Nurses Association, we have Michael Villeneuve, chief executive officer; and Aden Hamza, policy lead. From Doctors Without Borders, we have Dr. Jason Nickerson, humanitarian affairs adviser.

Before we go to the statements, I will advise everyone that I will be using a yellow card to indicate when there's approximately one minute left and a red card to indicate when your time is up. At that point, please try to wrap up.

We'll start with Dr. Langley.

Dr. Langley, please go ahead for five minutes.

[Dr. Joanne Langley, Professor of Pediatrics and Community Health and Epidemiology, As an Individual]

Thank you.

Good afternoon.

My name is Joanne Langley, and I am speaking to you today from Nova Scotia. I'd like to start by acknowledging that my workplace here at Dalhousie University and the IWK Health Centre sit on the ancestral and unceded territory of the Mi'kmaq.

Thank you for the invitation to the House of Commons Standing Committee on Health.

Thank you, members of Parliament, for your services to the country.

I'm a pediatrician specializing in infectious diseases. I'm also a vaccine researcher and clinical epidemiologist. I've been honoured to work over several decades with public health colleagues on communicable disease control and vaccines to prevent and limit the spread of infectious diseases. These challenges that we have worked on together include the 2003 SARS outbreak, various local and regional epidemics and the last pandemic in 2009 due to influenza. The current pandemic, which has affected the physical, mental, social and economic well-being of humanity across our globe, has been unprecedented.

All of us have been heartened by the speed at which science and dedicated hard-working humans have delivered safe and highly effective COVID-19 vaccines. These advances in vaccine development are also unprecedented, but the work is not over. There are important tasks ahead for this year and, in my view, likely for a few years.

We must not become accustomed to this suffering, which has affected all people, including children. Now is the time for lofty goals and for solidarity. Words and deeds matter. We must support our health care professionals as they take care of the sick. We must support our public health workers as they implement what is the largest vaccine rollout in our country's history. We must continue public health measures and support for them until we understand the natural history of this virus.

There is much remaining basic and clinical science research to be done, and we must continue to strive to collaborate across all the man-made divisions that exist now to work together. While we protect people within our own borders, we must continue to lift our gaze to the protection of the peoples of the world, to the low- and middle-income countries, and how we can serve them.

I'd like to make a few closing comments about the role of vaccines in ensuring a healthy society. Immunization has been cited as one of the top 10 public health achievements of the last century. When there isn't a pandemic, I would argue that vaccines do not always get the attention they deserve. At this time, Canadian children are protected against 16 different infections. Vaccination can prevent whooping cough, death, disability and serious illness. Adults, too, have a schedule of vaccines that can prevent influenza, shingles, pneumonia and other life-altering infections. Immunization is a strong and dynamic system, but somewhat fragile.

[The Chair, Liberal, Ron McKinnon]

Pardon me, Dr. Langley, your mike is just a bit too close.

[Dr. Joanne Langley]

Thank you.

I use the word “fragile” because a robust immunization program requires public confidence, high vaccine uptake, funding and surveillance to measure the impact of vaccine programs, and ongoing research.

I hope that this pandemic has sharpened our focus on the detection and prevention of infectious diseases, broadly speaking.

Thank you for your attention. I look forward to our discussion.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to Dr. Andrew Morris. Please go ahead, sir. You have six minutes.

[Dr. Andrew Morris, Professor of Infectious Diseases, As an Individual]

Thank you, Mr. Chair, and honourable committee members. It's an honour to be able to address this committee.

Before I begin, I'd like to acknowledge that I'm currently speaking from what I believe to be the unceded ancestral territory of the Haudenosaunee, which is where my family home currently rests.

I'm a professor of medicine at the University of Toronto and a consultant in infectious diseases at Sinai Health and the University Health Network. Prior to this pandemic, most of my academic work was really focused around antimicrobial resistance—drug-resistant infections. I've been doing work on behalf of the Public Health Agency of Canada, along with Gerry Wright, to develop a pan-Canadian network to tackle antimicrobial-resistant infections.

This is my third such appearance before the Standing Committee on Health in relation to infectious diseases in the past four years. I'm really privileged to be invited again. As I will remind this committee—in fact, the only familiar face I see here is Mr. Davies', so there are many new faces—much of the action that I've urged this committee to act on previously has not occurred.

Although it was self-evident at the beginning of the pandemic when the virus was first isolated, it's worth reminding everyone that COVID-19 is just one of a host of drug-resistant infections. There are many drug-resistant infections that affect Canadians annually. Sadly, we estimate that we've lost around 22,000 people to COVID-19 over the past 12 months, and many more have become sick. We lose about one quarter of that figure annually due to drug-resistant infections at a cost to the Canadian health care system of $1.4 billion, with a reduction in GDP of about $2 billion. We expect that those numbers are going to rise to about $7.6 billion in health care costs and $21 billion in GDP by 2050.

We're now roughly a year into this pandemic, and it would be sufficient to say that the lives that we're going to continue to see lost around the world, including in Canada, will be due to a combination of two things. One is insufficient vaccination, primarily limited by supply, and the other one will be ineffective antimicrobial therapy. I do want to point out, as Dr. Langley also pointed out, that as citizens of the world, both of these issues affect people throughout the globe.

We need to invest in infectious diseases prevention, surveillance, diagnostics and therapeutics. I think I'm going to attenuate what I was going to say for reasons of time, but I will point out that our surveillance systems in particular remain so poor that at present we've had to put together a hodgepodge of genomic sequencing resources to try to give us the surveillance information that countries like Denmark, which has one tenth of Canada's population, and the U.K., which has roughly double our population, can provide to their own citizens. We also lack the capacity to develop antimicrobials, and we're unable to produce vaccines to serve our citizens.

We have not been able to mount a coordinated response to infectious diseases, and I really want to focus for the next while on drug therapy. I will start by pointing out that there are two evidence-based therapeutic treatments for COVID-19 that unequivocally save lives in hospitalized patients: dexamethasone, which is a cortisone-like medication, and tocilizumab, which is a monoclonal antibody that blocks a component of the immune system. Both of these agents are life-saving with comparable and additive effects.

At present, we have sufficient supply of dexamethasone across the country. It's a cheap, generic drug. On the other hand, we have insufficient supply of tocilizumab for the needs of Canadians. Whereas I do understand that the federal government along with the provincial governments have been making efforts to procure sufficient supply, provinces have been sheepish to provide tocilizumab to patients whose conditions merit its use because of uncertain drug supply. This is an unquestionably life-saving drug.

The last point I want to make is to contrast these stories with the stories of remdesivir and bamlanivimab. Yes, if you're wondering, as an infectious disease physician I'm used to pronouncing organism and drug names that the rest of humanity struggles to pronounce.

Remdesivir is an antiviral drug whose effectiveness remains uncertain to me and many others, including the WHO. Bamlanivimab is a monoclonal antibody that targets the virus itself. It's a drug that the Canadian Agency for Drugs and Technologies in Health evaluated as neither practically implementable nor of clinical value.

The federal government, through Health Canada, purchased remdesivir at a cost that is not publicly known, but that I would estimate to be $75 million. On the other hand, the government also purchased what I believe to be $32 million worth of bamlanivimab. This expenditure of approximately $100 million on effectively useless drugs contrasts with the shortage of the two life-saving treatments that currently exist.

What is urgently needed is a pan-Canadian committee of national experts with experience in clinical practice guidelines and expertise relevant to COVID-19, comparable to NACI, the National Advisory Committee on Immunization, who can share knowledge and data and come up with sensible recommendations.

I'm sensitive to the challenges faced by our federal government in nudging provinces and territories to row in the same direction. Clearly, this is an area in which the government has not been successful. Accordingly, I, along with several of my colleagues from around the country who have been involved in the development of provincial guidance, have decided to mobilize, mainly because of the urgency of the need and the importance of this to Canadians. These challenges are too great to defer any longer to the various levels of government.

In the meantime, it would be wise for this committee and the federal government to figure out how our group of national experts can either be supported immediately or catapulted to a future state where such a committee exists for all infectious diseases. As I said at the beginning, drug-resistant infections are not going away, and we need to approach their treatment with a pan-Canadian, evidence-based lens that brings together the interests and expertise of all people from coast to coast to coast.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We now go to the Canadian Nurses Association, with either Mr. Villeneuve or Mr. Hamza. Please go ahead for six minutes.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Thanks, Mr. Chair, and I apologize for disappearing. We had a technical emergency at this end and I wasn't able to hear the first two witnesses.

I want to thank you, Mr. Chair, and members of the committee for inviting the Canadian Nurses Association to appear today. My name is Mike Villeneuve, and I'm the CEO at the Canadian Nurses Association. I'm delighted to have my colleague, Aden Hamza, who is our policy lead, here with me.

In December 2020, Canada reached a much-anticipated milestone, as you will know, as the first doses of the COVID-19 vaccine arrived and immunization programs began across the country. This gave nurses and people living in Canada the hope that the unprecedented global crisis may be brought under control. Never in history has the world of science come together at the same time to solve a common threat to humanity and, globally, scientists have deployed new techniques, shared their findings openly, and worked around the clock with governments and regulators while preserving safety.

Two weeks from yesterday, we will mark the one-year anniversary since the WHO declared COVID-19 a global pandemic. Day after day since then, health care workers and vulnerable populations have been suffering the most due to the pandemic. As a key step in eliminating this crippling virus from our society, the Canadian Nurses Association is strongly recommending that everyone living in Canada take the vaccine as it becomes available to them. In addition, clear guidelines and a strong nursing and health care workforce will be critical to successfully deploying a mass COVID-19 immunization program.

Nurses will be central to the delivery of the COVID-19 vaccines across Canada. In fact, it was a nurse in the U.K. who gave the world's first COVID-19 vaccine to a patient. As nurses, we historically have been at the forefront of immunization programs. A vast amount of vaccine delivery into the arms of human beings was carried out by nurses globally, and we have always been strong supporters of science. This was demonstrated in Canada as we saw many nurses be the first to roll up their sleeves to be vaccinated in December.

As the largest group of health care professionals in Canada, nurses are playing a critical role not only in administering vaccines but in educating the public and encouraging vaccine confidence. In carrying out their roles, nurses are ethically bound to give evidence-based, accurate, timely and non-judgmental information to patients. CNA has been committed throughout this process and is playing a key role in promoting vaccine acceptance and supporting nurses through clear, consistent messaging and evidence-informed resources.

I will conclude, Mr. Chair, by saying that CNA continues to be extremely concerned with the critical problems we've witnessed during the pandemic. The long-term care sector continues to suffer the most, and even with lessons learned from the first wave of the pandemic, the second wave has rehashed vulnerabilities in these homes and settings, leading to new outbreaks and many deaths of older adults.

We are also extremely concerned with the mental health and burnout of nurses and all health care workers in Canada. The worsening mental health of nurses could lead to long-term effects for those nurses as individuals but also for the health care system, including amplifying nursing shortages, which seems to be a concern in some parts of Canada. Last year, we asked nurses and found that their mental health had deteriorated significantly throughout the year with over half stating that their mental health was only fair or worse than fair.

Urgent action from all of us, certainly from governments, is needed to address these challenges. Federal, provincial and territorial governments need to remain vigilant and continue to hear the expert voices of nurses and other health care professionals.

Thank you, Mr. Chair, and Aden and I will do our best to answer any questions.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We'll go now to Doctors Without Borders.

Dr. Nickerson, please go ahead for six minutes.

[Dr. Jason Nickerson, Humanitarian Affairs Advisor, Doctors Without Borders]

Good afternoon, and thank you to the committee for having me back today.

It has been said many times that this is a global pandemic that requires global solidarity and global actions. In addition to protecting Canadians, it is essential that our government unite behind a truly global response. Doctors Without Borders, or Médecins Sans Frontières, MSF, teams have witnessed a severe second wave of the COVID pandemic in many of the places where we work. In places such as Mozambique, Malawi and Zimbabwe, health systems have struggled to cope with the sudden onslaught of patients. Several African countries have recorded more COVID-19 cases in the month of January 2021 than in all of 2020 combined, and in many countries, the indirect impacts of the pandemic, in particular the disruption of essential health services, have been even more deadly than COVID itself.

My key message today is that our immediate global priority needs to be ensuring that health care workers and other people most at risk in low- and middle-income countries have equitable access to the most effective and contextually appropriate COVID-19 vaccines urgently. Unless we scale up access to vaccines in all places, the world risks generating new pandemics of vaccine-resistant COVID-19 variants. If we fail at equitable distribution of COVID-19 vaccines, we fail at global public health. It's that simple. This would be morally catastrophic and a significant risk to the public health of all people, including Canadians.

There are billions of people in the world who are almost exclusively dependent on the Covax facility as the source of their vaccines, yet it wasn't until Wednesday of this week that the first doses from Covax arrived in the first recipient country. That's because Covax itself is struggling to access doses in a timely way, in large part because the existing supply has so far been monopolized by high-income countries.

I want to emphasize that the only reason for Covax's existence in the first place is because the way that the world currently develops, manufactures and delivers new medicines and vaccines is broken. It is set up to maximize profits. The pharmaceutical industry is not set up to rapidly respond to emerging pathogens with pandemic potential. It is not designed to scale up manufacturing of new health technologies to meet global demand, and as we are seeing today and have seen for decades, it is not set up to ensure equitable access to new medicines and vaccines, particularly for people in economically poor countries.

We need to change the way the world develops medicines and vaccines, to prioritize developing the tools needed to respond to public health threats and making them readily available and accessible. There are vast areas of medicine that cannot and simply do not respond to the market. They're market failures. COVID-19 clearly falls into that category. A year and a half ago, there was no commercial interest in coronavirus vaccines. The same is true of Ebola and drug-resistant infections. As Canada moves toward a conversation of biomanufacturing of medicines and vaccines, it's essential that this not just be a conversation about how to incentivize private companies to build factories here. It needs to be a conversation that transforms our relationship with the way that medicines and vaccines are discovered, developed, manufactured and delivered.

This committee actually studied this issue during its study on federally funded health research in 2018. None of the recommendations made by the committee in that report have been implemented, though they could have helped avert parts of this crisis by demanding fair pricing, greater transparency and sharing of technologies, and global access to drugs and vaccines developed with Canadian public funding.

It is common sense that when the federal government invests in vaccine or drug development it would ensure that the final product is available at a fair price around the world, including in Canada, but that's not what happens. We know that Canadians are concerned by this, because more than 90,000 people signed MSF's petition calling on the federal government to attach conditions to federal funding to ensure that the medicines and vaccines we pay to develop are affordable and accessible to people who need them.

We have three recommendations today for this committee. One, Canada needs a timeline for making a percentage of its doses of COVID-19 vaccines available for use in low- and middle-income countries to vaccinate health care workers and other high-risk people. Canada has publicly released timelines for when we anticipate having a surplus of doses, so Canada should release a timeline for the sharing of vaccines. This committee should ask for it.

Two, push for the implementation of the recommendations in the 2018 study on federally funded health research and open science, which recommended that Canada make the funding provided to develop new medicines and vaccines conditional on recipients ensuring that they would be available to people around the world at affordable, fair prices.

Three, we request that the Parliamentary Budget Officer review any drugs and vaccines that have been discovered and developed with Canadian public funding to understand whether, under a different model of production, we might have more affordable and accessible options for things like the rVSV-ZEBOV Ebola vaccine. This vaccine was first developed with Canadian public funding and to date costs $98.60 per dose, unquestionably the most expensive vaccine in use in global health.

As always, I'm happy to discuss any of this in greater detail. Thank you again for having me back.

[The Chair, Liberal, Ron McKinnon]

Thank you, doctor.

We now move to questions.

Mr. Paul-Hus, you have the floor for six minutes.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you, Mr. Chair.

Thank you to the witnesses for being with us today.

Ms. Langley, at the moment, there are serious delays with regard to vaccines. Contract management has been somewhat disastrous. Now our committee needs more information. You are part of the COVID-19 Vaccine Task Force, so I would like to know the following:

Do you agree that the minutes of the task force meetings should be published on the government's website and that the committee should be able to receive a copy?

[Dr. Joanne Langley]

Thank you, Mr. Chair, for the question about the minutes of the COVID-19 Vaccine Task Force.

To date, the limits on the minutes of the task force are related to the confidential business information the task force considers. We've tried to overcome this by holding a number of media interviews, offering to meet with the leaders of the political parties, and holding multiple seminars and sharing as soon as possible information that doesn't contain this confidential business information. We have all signed CDAs with the companies that presented to us.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you.

We understand that, but there is still a way to have minutes. Everyone is trying to understand what happened.

At the onset of the crisis, in 2020, the Government of Canada signed an agreement with CanSino Biologics. You're at Dalhousie University, so I believe you already have a relationship with CanSino. We're trying to understand what happened at that time.

Did you recommend that the Government of Canada do business with CanSino?

[Dr. Joanne Langley]

With regard to that particular vaccine, there are two separate processes.

The first was a research agreement with Dalhousie University and CanSino, which was a result of the scientific collaboration between CanSino and the NRC. That happened before the task force.

Second, CanSino, along with all the other international vaccines, was considered a potential candidate.

Roger, would you have anything to add to that in terms of detail?

[Roger Scott-Douglas, Secretary of the COVID-19 Vaccine Task, As an Individual]

No, I think that puts it very well, Joanne. You have drawn a pretty clear distinction between the work that the Canadian Centre for Vaccinology did early in May with CanSino, and then the subsequent work—

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you, Mr. Scott-Douglas.

Ms. Langley, how is it that Canadian intellectual property was transferred to the Chinese at CanSino and that the Chinese subsequently cancelled the agreement? Do you know why?

[Dr. Joanne Langley]

I think the assumption there is not quite correct. I don't believe—and Roger can explain this—that there was not actually intellectual property transferred.

[Roger Scott-Douglas]

That's right, Joanne. The IP was owned by CanSino. It was not NRC IP that was involved in the vaccine. CanSino did have access to the HEK-293 cell line, which is very advanced and used by many vaccine companies in the development of the product. However, all of the IP related to this particular vaccine was actually CanSino's, not the NRC's, and no money was paid to CanSino.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

All right, thank you.

I will ask my next question.

Currently, approximately 3 million Canadians are expected to be vaccinated by the end of March. However, by that time, 130 million Americans will have been vaccinated. According to Pfizer's press releases, Americans are vaccinating their population very quickly and there will be a surplus at Pfizer.

Is that why we will be getting more vaccines in April and May, because the Americans will be ahead of us and Pfizer will be able to supply us with vaccines through the United States as well?

[Dr. Joanne Langley]

I think your question is whether the relationship between the company and the U.S. is affecting Canada. I believe they're independent contracts. I'm not sure that they're procured from the same factories.

Roger, can you fill in the details there?

[Roger Scott-Douglas]

The Pfizer doses received by Canada, which are being referred to here, come from European manufacturing centres, not the U.S.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Yes, I know that the vaccines come from Belgium.

It is currently known that 130 million Americans will be vaccinated and that there will be a surplus of doses, since the United States plans to produce 2 billion doses.

Will Canada receive the surplus doses from the United States instead of just Belgium? Is this already planned?

[Roger Scott-Douglas]

I know that every effort is being made by government ministers to get safe and effective vaccines such as the Pfizer vaccine, and the Moderna and now AstraZeneca ones as quickly as possible to Canadians. They're looking at all destinations where that is possible. The current arrangements for Pfizer, though, are from the Belgian plant that you referred to.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Mr. Chair, I think my time is up.