Evidence of meeting #21 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was covid-19.
A recording is available from Parliament.
Don Davies NDP Vancouver Kingsway, BC
The reason I ask is that Dr. Kobinger said he voiced very strong concerns despite the fact that this was officially the first recommendation of the committee, but they had never really discussed the CanSino recommendations. We didn't know how it was made is the first recommendation.
Can you explain why a recommendation of CanSino was the vaccine task force's first priority?
Secretary of the COVID-19 Vaccine Task, As an Individual
It wasn't the first priority, and Dr. Kobinger only came to very few meetings—two and a half meetings. Most of the discussion occurred after he stopped appearing at the task force.
Conservative
Chris d'Entremont Conservative West Nova, NS
On a point of order, Mr. Chair, just before we get onto the next panel, I'd like to ask a question.
Conservative
Chris d'Entremont Conservative West Nova, NS
Thank you.
At the meeting last week there were a number of undertakings made by PHAC to provide us with some information. Have we received any follow-up information from PHAC on the questions we had asked?
Liberal
The Chair Liberal Ron McKinnon
We've received a number of submissions from various people. I don't know exactly if they've been resolved. That's a question we can ask the clerk.
The clerk is shaking his head no, so not at this time.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. d'Entremont.
I'd like to thank all of the witnesses for appearing today and giving their time, expertise and great answers.
We will now suspend and bring in the next panel.
Thank you all.
Liberal
The Chair Liberal Ron McKinnon
The meeting is resumed.
Welcome back, everyone.
We are resuming meeting number 21 of the House of Commons Standing Committee on Health.
The committee is meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.
I would like to welcome the witnesses.
As an individual, we have Dr. Cécile Tremblay, full professor, Université de Montréal. From the Canadian Association of Emergency Physicians, we have Dr. Alan Drummond, co-chair, public affairs committee; and Dr. Atul Kapur, co-chair, public affairs committee. From the Public Health Agency of Canada, we have Mr. Iain Stewart, president, who will be making a presentation. And we have Major-General Dany Fortin, vice-president of the vaccine rollout task force, logistics and operations, who will also be making a presentation.
We will start now with witness statements. I would remind everyone that I will be using a yellow card to indicate when there's about a minute left, if I don't forget, and a red card when your time is up. When you see the red card, please try to wrap up.
We will start with Dr. Tremblay.
Dr. Tremblay, you have the floor for six minutes.
Dr. Cécile Tremblay Full Professor, Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, As an Individual
Thank you.
My name is Cécile Tremblay, I am an infectious disease specialist and medical microbiologist at the Centre hospitalier de l'Université de Montréal. I hold the Pfizer University of Montreal chair on HIV translational research.
I have been working for decades on correlates of protection that could be used for vaccine development in HIV. This goal has long eluded us for HIV, so we've been thrilled to see the rapid development of viral-effective vaccines against COVID-19 in such a short period of time.
Several challenges persist. Vaccines do not stop pandemics; vaccinations do. Three factors will determine if herd immunity can be achieved in Canada through vaccination.
First is the availability of vaccine supply. Canadian researchers have been working hard on developing new vaccines. This work has been supported by the Canadian government through CIHR and other funding mechanisms. However, the time frame for the development of a new vaccine amenable to clinical trial in Canada is unlikely to yield products available for us in 2021.
I'm talking about the homegrown vaccines in Canada. These research efforts, though, should continue to be supported, as they may become useful if the pandemic persists, or if variants render our present vaccines obsolete.
At the moment, we have to rely on existing vaccines, which are in short supply not only in Canada, but throughout the world. Because of our deficient Canadian vaccine manufacturing infrastructure, we have had to rely on the importation of vaccines produced elsewhere with all of the delays that creates.
The lessons learned from previous pandemics had identified the need to produce vaccines in Canada as a priority, as part of a pandemic preparedness plan. Unfortunately, little was done and although we have had some companies manufacturing vaccines in Canada such as Sanofi Pasteur in Toronto and GSK in Quebec City, the capacity for large-scale production is limited.
The recent initiative of the federal government to develop a vaccine manufacturing facility in the Royalmount district in Montreal is commendable. Other facilities associated with research centres are also being created, such as the one in Saskatoon.
However, if we want to develop sustainable infrastructure for vaccine development and production in Canada, we must also support the presence of a variety of pharmaceutical industries, from homegrown biotechs such as Medicago in Quebec City, to big pharma. This will maintain the scientific expertise in Canada and avoid the brain drain of our young researchers to the U.S.
This means reversing an unfortunate trend over the last decade. In 2007, AstraZeneca and Bristol Myers Squibb shut down their manufacturing operations. In 2010 Johnson & Johnson and Merck's research centre in Montreal closed. Several other companies such as Pfizer, Abbott, and other research facilities that were based in Quebec were also relocated abroad.
If we want to make sure that we have sufficient vaccine supplies for the next pandemic, then we need to have an infrastructure that includes both a government-administered manufacturing capacity and a strong pharmaceutical industry presence.
The second factor in achieving herd immunity is the ability to establish mass vaccination programs that are accessible to the entire population. From what we can observe in Quebec, this seems to be quite well organized.
The third factor is vaccine hesitancy. This is not specific to COVID-19. Misinformation on vaccines has been circulating for decades, and has accelerated in recent years on social media. COVID-19 has intensified conspiracy theories, which have instilled fear in a significant proportion of the population.
To achieve herd immunity it is believed that 75% to 85% of the population needs to be vaccinated. At the moment a good percentage of the population is eagerly awaiting their vaccine. These are the low-hanging fruit. The challenge will be to reach out to those who are hesitant and not necessarily against vaccination, but who need to have their questions answered.
So far it is not clear to me what the communication plan is. People who are hesitant about getting vaccines are spread throughout society across all ages and socioeconomic strata. Specific communication strategies must be developed to address their various concerns.
Finally, phase three vaccine clinical trials usually exclude certain populations, such as immune-compromised and HIV-positive people, transplant patients, cancer patients receiving immunosuppressive therapies, and pregnant or breastfeeding women. However, we know that these populations could benefit from vaccines, but we are always in the grey zone, because data has not been collected. It could be, because of their immunosuppression, that their antibody response may not be as high or effective. We might need to use a different strategy, such as adding booster doses.
Usually researchers initiate research projects, like I do, to test vaccines in these populations. They apply for grants and, if they are lucky, they get funded. There's always a problem in accessing the product that we want to test to conduct these clinical trials.
With phase 4, this is particularly true when the supply is limited, such as the case right now, so testing new vaccines in these various populations should not be left to individual initiatives. It should be mandated by the government, and resources as well as vaccines should be available automatically to conduct these phase 4 trials once the vaccines are approved.
In the midst of this devastating pandemic, vaccines are the shining light on the horizon. Let us learn from previous pandemics and build a durable infrastructure encompassing research and development and manufacturing and distribution so that we are ready for the next time.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Tremblay.
We will go now to the Canadian Association of Emergency Physicians.
Dr. Drummond or Dr. Kapur, please.
Dr. Alan Drummond Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
I believe that's Dr. Kapur.
Dr. Atul Kapur Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
I apologize. I thought Dr. Drummond was going to lead us off.
Thank you for the opportunity to appear. We plan to utilize our time by focusing on the immediate situation of vaccination and the vital need to engage with frontline workers and their associations. There are other points that we will be mentioning later on.
Our first priority has to be to repeat our call for increased transparency around the prioritization and administration of the COVID-19 vaccines and the plans for the vaccinations going forward. Unfortunately, there remains confusion, lack of transparency and mixed messaging around prioritization. We urge there to be central, federal coordination of efforts with clear, consistent and transparent messaging.
Why are we calling for this? It's because we see the stark example of this problem in the fact that there are still people working in Canadian emergency departments who have not been vaccinated or not completely vaccinated. Of particular concern for us are those working in smaller, isolated and rural communities. We are highlighting health care workers because of the precarious state of the health care system and its dependence on workers who are already overstretched. Plainly said, if our health care workers are incapacitated due to COVID-19, the system won't be able to take care of the population at large. As I said, but it needs reinforcing, most troubling is the fact that vaccination has been delayed for emergency personnel in rural and isolated communities. The risk there is that because they don't have as many people and as many backup personnel, the smaller population of providers means that there are not others who can step up and fill in for colleagues who fall ill. The risk of system collapse in rural communities is much higher. That also has caused frustration for health care personnel and added to the burden of working in a system that was already overloaded even prior to the pandemic.
We as health care workers have been repeatedly thanked. We've been hailed as heroes. The reality is that we are workers, no less than any others, who deserve a safe work environment. Instead, all too often the assumption has been that we will simply accept increased risks without consistent, evidence-based assessment and mitigation of those risks. In fact, we even saw last week one provincial government fail to recognize that emergency department nurses are a higher-risk group that treats COVID-19 patients often before they have been identified as cases.
Our members and our colleagues on the front lines have continued to step up and care for the sickest patients in our communities. Transparency, communication and adherence to an ethical framework in vaccine prioritization and administration are the minimum they should receive in return. We have seen many missteps up until now. We are looking forward to the ramp-up, but we want assurance that those missteps won't be enlarged and expanded as we ramp up.
We also want to talk about the conditions that hindered the response to the COVID-19 pandemic and that need to be addressed now in order to prevent a third wave that's even worse than the second and to support the health care system’s ability to respond and to resolve vulnerabilities prior to the next health care crisis. Think about the idea of a system that's resilient and able to respond. It needs surge capacity, which is eliminated when there's pre-existing crowding. It needs adequate staff, which requires HHR planning. It requires adequate supplies, which requires stockpiles, domestic production capacity, and a strategy to prevent shortages of medications and supplies. It needs an appropriate working environment, which requires hospital design. It requires adequate leadership and decision-making, such as an incident management system and clear communications.
At the beginning, we emphasized the point of keeping the system resilient, which requires vaccinating staff so that the capacity is there. I'll touch on a couple of these points specifically.
When we talk about surge capacity, we saw that hospitals completely shut down in wave one in order to create capacity to handle anticipated COVID-19 patients. Hospitals function most adequately and appropriately at 85% capacity. Even before COVID, most hospitals in this country were operating at or above 100%. That is not suitable; it is not appropriate. It wasn't then. It isn't now, and it won't be in the future.
We cannot go back to the old normal. That has added to the strain on emergency department workers. We have been and are continuing to see emergency department staff leave the emergency department to work elsewhere or leave the profession. Unfortunately, we have also seen at least one colleague who has been lost to suicide in the last year.
I see that my time is coming to an end. We have submitted a written brief with more details and we will be happy to answer questions from the committee.
Thank you.
Liberal
The Chair Liberal Ron McKinnon
Thank you.
We'll now go to Mr. Iain Stewart, president, Public Health Agency of Canada.
Please go ahead for six minutes.
Iain Stewart President, Public Health Agency of Canada
Thank you, Mr. Chair and members of the Standing Committee on Health for inviting Major General Fortin and me to return today to inform and discuss with you our work on vaccines.
The Government of Canada has taken a whole-of-government approach to much of the work we have been undertaking in response to the pandemic. We've been relying on accumulating scientific data and emerging evidence and we've been pulling on expert guidance to inform our decisions, strategies and recommendations. We're also participating in international communities of practice in order to benefit from the experiences and developments in other countries.
As you know, we've begun our phased approach to vaccinating Canadians. I'm pleased to say that we are in track to complete phase one by the end of March. As expected, we're ready to move on for phase two in April. Major General Fortin will be speaking more about the upcoming “big lift” we require to get ready for the influx of additional vaccine doses.
Last fall, the vaccine rollout task force was established inside the Public Health Agency of Canada in order to provide public health and strategic policy advice to decision-makers and also to oversee the management of the delivery of the vaccine portfolio. That included logistical planning and tracking of data on a secure platform as vaccines are deployed and distributed across Canada and to provide leadership and support to the various fora of the immunization experts like the National Advisory Committee on Immunization or the special advisory committee. It is also managing vaccine surveillance programs for issues such as vaccine safety, effectiveness of the vaccines and the coverage of the vaccines as we deliver them.
In order to fulfill its mandate, this internal task force is working closely with provinces, territories, indigenous leaders and communities across the country to support a consistent approach to COVID-19 immunization. The task force's expert advice and leadership have been invaluable over the past quarter and will be invaluable going forward as we move into the second phase.
Throughout the pandemic, public health practices and efforts of all Canadians have proven to be effective in containing the spread of the virus. Our efforts have brought us this far, but we have to continue wearing our masks, washing our hands and physical distancing as we move forward, until the immunization campaign is well advanced.
We also need to rely on effective border measures to mitigate the further introduction and spread of the virus and the virus' variants into Canada. That is why as of this month, travellers arriving in Canada have to produce at the border a molecular test done before arrival in Canada. They are tested again on the day of arrival and on day 10 of their quarantine. They have to continue to present quarantine plans that are appropriate and contact information for us for following up with them.
COVID-19 virus variants of concern have emerged in countries around the world. There is evidence that these variants are more easily transmitted. There is the risk that they cause more severe illness. These variants require our attention and we need to track them. We need to learn more about them and we need to use science to guide us.
In this regard, the Government of Canada recently allocated $53 million in funding for an integrated variants of concern strategy that builds on sequencing, research and surveillance capacity for detecting the variants and informing public health measures. This vital work has provided decision-makers with the latest science on controlling for variants of concern and will continue to respond accordingly and explore options for variants, such as vaccine boosters to control against their spread.
Canada has successfully secured a diverse portfolio of vaccines to vaccinate everyone in Canada who wants to be vaccinated, by the end of September. To this end, Canada has negotiated advance purchase agreements with seven pharmaceutical companies. This includes a diversity of vaccine technologies, including two mRNA vaccines, which are Pfizer and Moderna. As of this morning, as you'll know from the announcements, AstraZeneca has been authorized by Health Canada as well.
Several other vaccines are currently under review using the rolling review process Health Canada has developed. AstraZeneca will help with the immunization campaign starting relatively soon. I believe today, as well, an announcement was made about initial early doses, which will help us begin to take on board these new viral vector vaccines as part of our immunization campaign.
Last fall, NACI, the National Advisory Committee on Immunization, identified priority populations that would be vaccinated first. In anticipation of increased supply, they will be updating their advice on who should be the priority populations. We will continue to be guided by their evidence and their advice in the work that we do.
Thank you very much, Mr. Chair.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Stewart.
We go now to Major General Dany Fortin, vice-president of the Vaccine Roll-Out Task Force, logistics and operations.
Please go ahead, General, for six minutes.
Major-General Dany Fortin Vice-President, Vaccine Roll-Out Task Force, Logistics and Operations, Public Health Agency of Canada
Thank you very much, Mr. Chair and members of the standing committee. I'm pleased to provide the committee with an update on the progress we've made so far and our plans for moving forward to provide all Canadians with vaccines by the fall.
So far, the national operations centre here at the agency has distributed nearly two and a half million doses of both approved vaccines—Pfizer-BioNTech and Moderna—with approximately three and a half million coming next month to round out our six million announced commitment from both manufacturers.
Since last December, we have been working on a plan that will allow us to deliver authorized vaccines safely, efficiently and as quickly as possible to provinces and territories. We deliberately implemented a phased approach so we could establish our capacity to distribute vaccines and support the provinces and territories to administer the vaccines. We completed a series of tabletop exercises and various discussions and rehearsals with the provinces and territories to ensure that all critical capability gaps were filled, risks were identified and mitigated, that the plan was resilient and contingencies were in place to secure the vaccine supply chain. That continues today.
As part of our soft launch approach last December, we started with early deliveries of authorized vaccines to 14 designated points of use on the 14th of December across Canada. As we moved forward, we expanded the number of distribution sites. Last week alone, 107 vaccination sites were used for Pfizer and 83 for Moderna.
Also, I personally conducted multiple bilateral meetings with counterparts from provincial and territorial vaccine rollout leads as well as federal stakeholders to ensure that we're all on the same page. We continue to have those moving forward.
Over the last two months, Canada was significantly affected by COVID-19 vaccine shortages and delays as Pfizer-BioNTech and Moderna reduced production rates at their respective European facilities. This created a temporary delay for deliveries to Canada, but the improvements in manufacturing are now allowing for greater productivity. We are now coming out of this trough.
From the beginning, we have been open with our partners and stakeholders about fluctuations in supply and the need for contingency plans.
I want to emphasize that we are expecting 444,000 doses each week in March from Pfizer-BioNTech and that Moderna will send the full 2 million missing doses. We are on a very good track from our perspective.
From April onwards, we expect a sharp increase in the availability of licensed vaccines against COVID-19. As we announced this morning, we will receive two new vaccines from AstraZeneca, and these quantities will be added to the totals for these two productions.
More than 23 million doses are therefore expected to arrive between April and June. This includes the advance delivery of an additional 2.8 million doses of Pfizer-BioNTech, which was planned for this summer, but will now occur in the spring.
The National Operations Centre at the Public Health Agency of Canada continues to lead the planning effort to ensure that the provinces and territories keep pace with the increased deliveries of licensed vaccines. In addition, the National Operations Centre continues to ship different types of freezers to ensure ultra-cold and cold chain storage for different products, further building capacity in the provinces and territories.
Our collective efforts over the past months and weeks, the initial testing of our distribution and logistics systems, and the launch of the Pfizer-BioNTech and Moderna vaccines have all served to set the stage for rapid scale-up in anticipation of the increased availability of vaccines in the coming weeks and months. The same approach will be taken in the coming weeks for the additional vaccines, in close collaboration with the provinces and territories.
Coordination and collaboration with our federal, provincial and territorial partners is key to the success of this operation. We regularly give them updates or inform them of changes to the distribution plan and ensure that we give them as much visibility as possible on future quantities as soon as we can.
Mr. Chair, in conclusion, our work to enable our provincial and territorial counterparts continues to be done proactively and transparently. This is a co-operative effort that touches on everything from vaccine availability to enabling equipment, to considerations by health care practitioners. We're are in close coordination, and we will continue to be so over the next several months. Every step of the way, to ensure that vaccines continue to be delivered efficiently and safely across regions in Canada, we've been working collaboratively with all stakeholders, and we'll certainly endeavour to do so moving forward.
With that, subject to your questions, this concludes my introductory remarks.
Thank you, Mr. Chair.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Major General Fortin.
We will now move to questions.
Mr. Paul-Hus, you have the floor for six minutes, please.
Conservative
Pierre Paul-Hus Conservative Charlesbourg—Haute-Saint-Charles, QC
Thank you, Mr. Chair.
Hello everyone.
I thank the witnesses for being here.
I will address you first, Major General Fortin. It is a pleasure to see you again.
In your speech, you talked briefly about coordinating with provinces. First of all, I want to clarify one thing for everyone: you are responsible for the logistics of vaccine distribution in the country, but you are not the one who signed the contracts in advance or negotiated them. You are in charge of distributing the vaccines that are delivered.
At first, the quantity of doses to be distributed was very small, but now, we are going to receive a lot of vaccines at the same time.
Have the provinces raised an objection saying they can't handle it, or is everything okay?
If there are problems, which provinces are concerned?
MGen Dany Fortin
I thank the member for his question.
This is an ongoing effort that will continue over the next few weeks. However, over the past few weeks, we have been working with the provinces and territories to determine their needs and capacity to deliver vaccines.
I'm pleased to say today that some provinces are well advanced in establishing vaccination mega-sites, mobile clinics and drive-through sites. There are also plans at all levels, including plans to use pharmacy distribution systems, which also involve pharmacists. There are also plans to hire retired people or people who do not usually administer vaccines to contribute to this effort.
Since provinces and territories are responsible for their own immunization programs, they are learning from each other.
Conservative
Pierre Paul-Hus Conservative Charlesbourg—Haute-Saint-Charles, QC
Major-General Fortin, let me give you an example.
You say that we will receive 23 million doses between April and June. With this information, you are well positioned to make a plan. Each province is able to know how many doses will arrive, but are there any logistical problems right now?
For example, even if it is offered 5 million doses, Quebec may not have the capacity to receive them. Is that being taken into account?
Are there provincial concerns?