Health Committee on Feb. 26th, 2021

[The Chair, Liberal, Ron McKinnon]

You still have 30 seconds.

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

Ms. Langley, if you had to do it all over again, what would you do better in terms of vaccine contract management?

[Dr. Joanne Langley]

Mr. Chair, the vaccine task force is not responsible for the rollout.

As an individual, I think it's a huge endeavour that we don't have regular practice with. I think we will learn from this in terms of pandemic planning and how to better deliver mass vaccination rollout programs in the future.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Paul-Hus.

We go now to Dr. Powlowski.

Dr. Powlowski, please go ahead. You have six minutes.

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

I think the big news for all Canadians today on the vaccine front is that the AstraZeneca vaccine was approved. We apparently have 20 million doses ordered.

Looking at the numbers, I'm not sure what to think of it. I would note that Health Canada has pointed out that some places have not allowed its use in those over 65. Health Canada regulators have said that the results are too limited to allow an estimated efficiency in those over 65. There seems to be a note of caution about its use for those over 65.

Now its efficacy seems to be a matter of question. The initial trials, I think, showed 62% generally, but when you used half the first dose, it was up to 90%. I see Health Canada is suggesting right now that it's 62% and WHO says 63% after eight to twelve weeks. However, there have been a number of studies reporting that after eight to twelve weeks with one dose, efficacy is 76% to 82%. This is perhaps somewhat confusing.

Here's the biggest number and the most interesting study, which doesn't seem to be that well reported. I think maybe the most significant evidence, apparently, is coming out of Scotland where they have over a million people vaccinated and over 400,000 people have received the AstraZeneca vaccine. They're reporting 94% reduction in hospitalization of those having had the AstraZeneca vaccine. That's surprisingly lower than those who had the Pfizer one. Moreover, those numbers for AstraZeneca's preventing hospitalization were of those aged over 80 years old, primarily.

Maybe we can start with Dr. Langley and Dr. Scott-Douglas from the task force, on Pfizer or on AstraZeneca and specifically its use in the elderly. Where is this going to slot in if we're not going to use it in the elderly?

[Dr. Joanne Langley]

I can start, Mr. Chair.

Thank you very much for the question and the wonderful summary of the evidence so far.

I think your summary has highlighted a couple of points, and I'll just deal with them briefly. One is that each trial has a slightly different efficacy outcome. When you compare a trial where the outcome is a positive PCR test plus one symptom with a trial like the AstraZeneca one, where the outcome is severe illness or some kind of really significantly important clinical illness, they're apples and oranges, and you can't compare them, so across these trials we have to be very cognizant of what we're comparing. Also, none of them have been compared head to head.

The second thing is that what we're seeing now is evidence from the fourth phase of clinical research, which is post-market authorization. This is a very important part of learning about vaccines where we see what the efficacy and effectiveness is in true rollout programs, so we have to continue observing that. I think we have complete confidence in Health Canada's review of the file and that it is a safe and effective vaccine and an important part of the armamentarium to wrestle this pandemic to the ground.

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

Dr. Morris, do you want to comment on AstraZeneca and/or its use in the over 65 age group?

[Dr. Andrew Morris]

There is really not much more to add to what Dr. Langley said. The real challenge is that most of our research experience is in adults younger than age 65, but the growing real-world experience is that it is effective, but it's going to be a matter of time in the post-marketing data for us to collect and really get more information on it.

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

Dr. Morris, while I have you, you seem to feel that bamlanivimab was totally useless. Maybe you could comment on the Chen et al. study in The New England Journal of Medicine. Their numbers were such that when it's used early, I think it decreased emergency room and hospitalization rates from 6.3% to 1.6%, and, in those who are either obese or over 65, from 14% to 4.6%.

Then, there's the BLAZE-2 trial. Dr. Silverman at Western, the head of infectious disease, said about bamlanivimab that apparently there have been six different groups of infectious disease people in Ontario trying to use it and, according to Dr. Silverman, there are no trials suggesting that it doesn't work whereas there are several suggesting that early on in the disease it is effective, so....

[Dr. Andrew Morris]

I'm not exactly sure what the question is, but I can comment on it.

I will say that the data that we have from the trials so far is markedly limited. The number of end points is quite small.

There are two real challenges with bamlanivimab. One is identifying the people who will benefit, which is difficult to do early on. The number of people who would need to be administered the drug in order to prevent just hospitalization is in the order of about 100 people just to prevent one hospitalization.

More importantly, because it's a drug that needs to be administered intravenously, the course of therapy is really two hours: one hour for it to be administered and then another hour of observation. We would have to do that for the people who are most infectious early on in their course when they would be most infectious. On top of that, in order to identify them, first you need to get a positive test. What would normally happen in most centres around the country is that someone would be tested, and then they would get their information two or three days later. Then they would have to be brought back when a lot of that early benefit would be lost. For all of these reasons, the implementation challenges as well as the lack of information, it is a drug that, at the moment as far as we know, doesn't hold tremendous promise.

I will also point out one other thing that has been observed in the BLAZE trials. When bamlanivimab is used as monotherapy—it's used alone—we see these escape mutants, which are variants that are resistant to some degree to the immune system, escaping. What we would rather have and what the evidence suggests is combination therapy. We don't have a second drug, and obviously that adds to more complexity and cost.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Morris.

We go now to Mr. Thériault.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I thank all the witnesses for their important testimony.

Mr. Nickerson, I remember a brilliant presentation that was made at the beginning of the pandemic. I was impressed and thought it was an interesting and relevant perspective. Indeed, the global pandemic has confounded all the experts who, for too long, thought that the virus would remain in mainland China. We now know that the virus is not staying in mainland China and that we are facing a global problem. Vaccine protectionism has been chosen as the solution. How do you explain this?

As my colleague Mr. Powlowski said, the vaccines will be delivered. So shouldn't Canada drop the idea of tapping into the COVAX bank?

[Dr. Jason Nickerson]

I think the point you're getting at is that this is a global public health emergency and what happens in one country affects all of us everywhere. Disease control and public health interventions that are applied inequitably or only in one country will simply not be effective at ending the pandemic. We live in an interconnected world, where disease knows no borders.

To the question of vaccines and vaccine access, I think it's very clear that what we have seen over the past three months, as vaccines have started to roll out, is that the vast majority, almost exclusively all, of the vaccine doses that have been administered have been administered in high-income countries. As I said, there are only this week shipments of COVID-19 vaccine doses arriving in countries through the Covax mechanism. A large reason for that is that the available vaccine supply has largely been monopolized by high-income countries up to this point. We face a fundamental problem of high need, high demand, and extremely limited supply up to this point.

On the issue of Covax specifically, I want to be very clear that I actually think that Canada's participating in Covax as a purchasing country was appropriate at the outset. This mechanism was intended to be a global procurement mechanism that would be guided by principles of equitable access to prioritize high-risk health care workers and other vulnerable people as a global priority. That was the deal. We vaccinate the people who are at highest risk in every country everywhere as a matter of urgency. Having purchasing countries participate in that to demonstrate that we're not just invested in this as a charitable function but also as a mechanism for changing the way we procure and distribute vaccines I think was appropriate.

To then also sign bilateral agreements for a large number of vaccine doses, which is the situation Canada and other high-income countries are in today, and to then go and draw on the Covax mechanism at the same time as effectively monopolizing the global supply—I think that's not appropriate. The solution here is that Canada should sit this first round out, because we need those Covax doses to be going to countries that are entirely dependent on Covax as their procurement mechanism and who don't have the same kind of bilateral deals that Canada and other countries have.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Morris, I am going to take advantage of our meeting to create a dynamic.

Do you agree with Mr. Nickerson?

[Dr. Andrew Morris]

I do, as a matter of fact.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Morris, I wanted to ask you about Remdesivir and bamlanivimab, and my colleague did.

You are advocating a tightening of sanitary measures. What more needs to be done to achieve the zero COVID target that you advocate?

Are we on the right track, or are there measures that we should tighten up further? In which settings does this apply?

[Dr. Andrew Morris]

That's probably a 10-hour conversation. I will try to narrow it as much as possible and focus first on the public health measures you have suggested.

I think one thing we haven't done well in Canada in particular is to take on a national or pan-Canadian strategy. Instead, we have a mixture of strategies. The territories and the Atlantic provinces have taken a maximum suppression approach. That has unquestionably saved lives, and it doesn't appear to have substantially harmed their economy, whereas all of the other provinces have taken a pure mitigation approach. How do you get there? I don't think there's any question of how you get to a maximum suppression strategy. The Atlantic provinces and the territories have demonstrated how to do that. That includes tight controls on the movement of people and travel, aggressive testing, contact tracing, isolating and supporting those who need help in all those aspects.

It's a very data-driven approach that targets zero, even though you may not actually achieve zero. I think as a national strategy, if there were to be a national strategy, then all the things that would be included in those would be necessary.

It looks like I don't have time to answer on the drugs.

[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, Mr. Chair.

Thank you to the witnesses for being here.

Mr. Scott-Douglas, last week you appeared at the industry committee, where you said the following:

We looked at all the other task forces, including Warp Speed. What Canada is doing is largely equivalent to what everybody else is doing. There's a great deal of confidential business information, and that necessitates that meetings be held in confidence, the same as almost every other task force.

Of course, the difference is that the U.S. vaccines and related biological products advisory committee does publish its agenda and its conclusions. Its entire meetings are webcast on YouTube for anyone to see. Why can the U.S. be transparent and Canada can't?

[Roger Scott-Douglas]

I think that's an excellent question. Transparency, to the degree possible, is obviously the goal we should all be seeking to achieve, though the work of the vaccine task force is not equivalent to the group you've identified in the United States. That is more equivalent to the regulator in Canada, Health Canada.

The work of Warp Speed, where they were dealing with sensitive and confidential business information and making decisions at an early stage that were then subsequently authorized through the FDA, etc., was done in confidence because of the confidential business information we've talked about. That same practice was generally followed by all of the leading vaccine task forces. The work of the regulator is a little different.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Got it.

The federal vaccine task force has a declaration of interest protocol, which requires all members to give a full disclosure of activities and interests that could place them in a potential conflict of interest to the federal government. Is there a reason why those members' disclosures have not been made public?

[Roger Scott-Douglas]

It is extremely important that the decision-making around advice given by the task force is made fully aware of potential conflicts of interest and interests generally. The ministers of ISED, health, and procurement are made fully aware of all of the interests relevant to advice given in that context. In any case where the government has acted on that advice and has announced the funding of projects, or commended it, the interests of the task force members relevant to those decisions have also been made fully public.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Dr. Langley, drawing on the advice of the vaccine task force last September, the federal government pre-ordered 72 million doses of the vaccine candidate developed jointly by GlaxoSmithKline and Sanofi. It's Canada's second-largest vaccine supply agreement.

I think you currently hold the $700,000 CIHR-GlaxoSmithKline chair in pediatric vaccinology at Dalhousie University. I believe you have worked with Sanofi on research and as a consultant in the past. By standard conflict measures, was it appropriate for you to not recuse yourself from discussions relating to the GSK-Sanofi vaccine candidate?

[Dr. Joanne Langley]

Thank you for the question.

To clarify, the research chair that I hold was an endowment that started to be developed between 2000...and was ultimately posted as an application on the Canadian Institutes of Health Research website. The endowment funds came from the Canadian Institutes of Health Research, the Dalhousie Medical Research Foundation, the department of pediatrics, several other smaller charitable agencies, as well as GlaxoSmithKline.

With an endowed chair, the money goes to the holder of the chair, which is Dalhousie University. The funds that arise from the endowment are then used to support research.

[Don Davies, NDP, Vancouver Kingsway, BC]

With respect, Dr. Langley, I don't need to understand how it works. I do understand. I'm asking if you think it was appropriate not to recuse yourself given the clear link, financially, between GlaxoSmithKline and the position that you hold.