Evidence of meeting #23 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was vaccine.
A recording is available from Parliament.
Executive Director, Oxfam Canada
My understanding is that up to 80% of research and development expenses were publicly financed, but I can turn to Madame Demarais.... I think that is usually the case.
We need to understand that these are not normal circumstances. These are extraordinary circumstances. That's why we need to take extraordinary measures.
Global Forecasting Director, The Economist Intelligence Unit Limited
My understanding is that these vary greatly vaccine by vaccine, so it's hard to make an average, but I've heard the figure of 80% for some vaccines in some countries.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Ravon, we've talked about COVAX, and I would say it's now infamous that Canada is securing 1.9 million doses of AstraZeneca vaccine from the COVAX program this June. Recent news, by my math, shows that the Government of Canada now claims to have secured delivery of 117.9 million vaccine doses by the end of September, which is enough to vaccinate every single Canadian three times over.
Is it justifiable for Canada to be taking 1.9 million doses from the COVAX program, given those numbers and given what you have told us about the lack of doses in the developing world?
Executive Director, Oxfam Canada
To be clear, we think that Canada should not be taking doses from COVAX. That being said, we think there's a bigger problem of production.
Even if we didn't take those million-plus doses, we still don't solve the problem for the world. There's no way, even once we're vaccinated in Canada, that we can go fast enough to vaccinate everyone else with the doses available now. That's why our focus today is on ramping up production and opening up intellectual property rights, so that developing countries that have the capacity to produce are doing it.
The problem with the current system is that someone like me, a young woman who's perfectly healthy, will be vaccinated before a health care worker in a developing country who is on the front lines of the disease.
That's why we need to shift things around. It's not a bidding war—who pays the most to get the vaccine—but that the vaccines are distributed according to need and vulnerability. That's not how things are working today, and there's an easy answer to this around intellectual property rights.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Madame Demarais, last week the European Union blocked a shipment of the AstraZeneca vaccine destined for Australia after the drug manufacturer failed to meet its EU contract commitments. According to Reuters, the EU is also planning to extend this export authorization scheme for COVID-19 vaccines to the end of June.
You were quoted in a BBC article, Madame Demarais, as saying, “As long as the European market doesn't have enough vaccines, I think that big imports to Canada are going to remain off the cards.” Do you expect that future vaccine deliveries to Canada may be disrupted by EU export controls?
Global Forecasting Director, The Economist Intelligence Unit Limited
The only thing this highlights is the production issue that Ms. Ravon just mentioned. I think it's unprecedented for everybody around the world to want to have a vaccine at the same time, so this is really making production an issue, and it's really going to be difficult this year to produce enough vaccines for everyone.
Then there's a political issue. Obviously, a number of countries are prioritizing vaccinating their domestic population first because they are under intense political pressure to do so, especially in western countries. In the European Union, all the debates in all the newspapers at the moment are all about whether the vaccine rollout is fast enough. In this situation, it's very hard to imagine that the European Union will allow large quantities of vaccines to be exported abroad in the coming months. As you mentioned, Italy has blocked some shipments of AstraZeneca vaccines to Australia, so it's not impossible to imagine that this could happen again.
Again, this really highlights two issues. The first one is production. There is a need to ramp up production to be able to vaccinate everyone this year. That's not going to be possible. The second one is that this has become a very political topic.
NDP
Don Davies NDP Vancouver Kingsway, BC
To all witnesses, it seems that a very clear theme is coming up. We're allowing a handful of private, multinational corporations in the world to control the production of a vaccine that is needed by seven billion people around the world.
Given that most of the development of the vaccine was financed publicly rather than through risk capital, does anybody disagree that we should be temporarily changing the way that we protect intellectual property so that every country can produce vaccines by making the technology and the intellectual property globally and publicly accessible? Does anybody think that's a bad idea?
Professor of Epidemiology, University of Toronto, As an Individual
I'll be the contrarian. I think it's a difficult challenge. I don't think it's a good or bad idea. I think the reason it's a challenge is that one can see arguing this in the short term very much in favour of trying to just expand global vaccine supply as fast as possible. I understand that and I think we've had precedent for that with HIV drugs previously where drugs have been, I believe, manufactured in India even while on patent, in violation of patents, because it was an emergency. I think there's precedent.
That said, I'm going to go out on a bit of a limb here. These vaccine multinationals are massive companies—you see that manifested in such names as GlaxoSmithKline and Sanofi Pasteur. There's been this sort of merger mania for about 30 years in the vaccine industry, which has resulted in these very large players. A lot of those players are actually filling an important global role. When it comes to manufacturing vaccines, this is not 1910 in Toronto, where you bought a stable and you harvested serum from horses. The quality issues, the potential liability issues and the fact that it costs about a billion bucks a vaccine to bring a vaccine to market make this a challenging business and sort of push it towards very large players. There are advantages to that.
Professor of Epidemiology, University of Toronto, As an Individual
Sure.
I think what you want to do is to try to increase supply rapidly without making this an unattractive area for companies in which to work in future. I'd love it if we could circle back around to what our future challenges are going to be, because COVID is going to be done at some point. We're going to get through this whether we vaccinate or don't vaccinate against pandemics. We have a whole list of pathogens that can do exactly the same thing that COVID has done, and we need vaccines against those pathogens too, which is a problem because it's hard to make these things when we're in the middle of a pandemic. If we're making them in the middle of a pandemic, we're too late.
Liberal
The Chair Liberal Ron McKinnon
Thank you, doctor, and thank you, Mr. Davies.
That brings us to the end of this panel and of the questions.
I'd like to thank all the witnesses for sharing your time and expertise with us today. Thank you for your great answers.
We will suspend and bring in the next panel.
We are suspended.
Liberal
The Chair Liberal Ron McKinnon
I call this meeting back to order.
We are resuming meeting number 23 of the House of Commons Standing Committee on Health. We are meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.
I'd like to welcome the witnesses.
For this panel, we have Dr. Ève Dubé, researcher, Research Center, Université Laval; and Dr. Nathalie Grandvaux, professor, Université de Montréal. From Pfizer Canada we have Mr. Pinnow, president.
We will start with witness statements.
Dr. Dubé, please go ahead for six minutes.
Dr. Ève Dubé Researcher, Research Center, Université Laval, As an Individual
Thank you.
I guess I am here as a medical anthropologist working on vaccine acceptance.
I'd like to emphasize that at this time our vaccine supply does not meet vaccine demand and that the work we're doing in Quebec looking at vaccine intentions indicates that most Canadians are willing to be vaccinated.
We can see vaccine acceptance in a continuum ranging from a very tiny minority of people who are strongly opposed to vaccination—it's fewer than 2%—to the vast majority of people who are willing to be vaccinated.
In the middle are the vaccine hesitant, the movable middle. Those groups are a bit more concerned about vaccine and maybe more reluctant to get their vaccination, and that's the group among whom we're seeing the most public health gains in ensuring confidence and acceptance.
Our regular surveys conducted in Quebec are similar to those done elsewhere in Canada. They indicate that three out of four people are willing to be vaccinated, but of course between an intention and actual behaviour there's a gap, and we need to ensure that barriers to vaccine acceptance are understood and well addressed.
These could be grouped in three main categories.
First is complacency. Depending where you live in Canada, if there are no COVID cases around you, you might be less willing to get the vaccination.
The second one is confidence. It's the level of trust that people have in the public health authority and the government to make good decisions concerning vaccination and to ensure that information is available to make an informed decision about vaccine.
The last one is convenience. It's something we tend to overlook, but the ease of getting access to a vaccination, of making an appointment, of being reminded that it's your turn to be vaccinated, is also important.
Thank you.
Liberal
Dr. Nathalie Grandvaux Professor, Faculty of Medecine, As an Individual
Thank you.
Good afternoon, Mr. Chair, members of the committee and fellow witnesses.
First of all, let me thank you for the opportunity to appear before you today.
Just to present myself a little bit, I am a full professor in biochemistry and molecular medicine at Université de Montréal, and I am also the director of the research laboratory on host-virus interaction at the Centre de recherche du CHUM, also in Montreal.
In that matter, I have been studying the mechanisms of human defence against respiratory viruses for 15 years now. Since April 2020, I have also been the co-director of the Québec COVID - Pandemic Network, which promotes research collaboration to accelerate discoveries and their applications.
At this point in the pandemic, I believe Canada faces several critical challenges for the immunization strategy to be successful. There would be plenty to discuss, but in the interest of time, I will only focus on two essential elements for which I see major inconsistencies these days, and for which I would like to propose avenues of improvement.
First of all, I would like to underline the work of the COVID-19 task force, with their recommendation of a diversified portfolio of vaccines. This was, in my opinion, an informed choice considering the impossibility of knowing a priori the success of each of these vaccines, and also because of our lack of production capacity. Likewise, the logistics for bringing vaccine doses to the provinces and territories is efficient, and I think this should be emphasized.
However, we now have four vaccines authorized by PHAC, and this is amazing. A major problem, however, is the confusion of messages regarding their use, as Canada, in my opinion, does not speak with a single, strong voice. PHAC authorizes vaccines based on the clinical trial data, and the NACI subsequently adjusts the recommendations for their use based on real-life data as it becomes available.
It goes without saying that the different messages emitted by these two organizations lately induce a major confusion that is incomprehensible for the majority of the population. This is without taking into account the additional confusion induced by the different opinions of the provincial advisory committees.
We are living in an exceptional crisis situation, but in the way our organizations operate, in my opinion, they have not been adjusting accordingly. NACI and PHAC should collaborate more closely and should unite their voices to deliver a single, clear and cohesive message. It is important to understand that inconsistent messages will likely lead to a loss of confidence in the population in the vaccination campaign and one cannot risk losing the adhesion of the population to immunization with the safe and effective vaccines that we have. I therefore urge the government to review the mandates of NACI and PHAC to include collaboration to reach a consensus to update the policies.
The most important problem, in my opinion, is undoubtedly that NACI's recommendations are not always based on scientific evidence, but in some cases on assumptions and expert opinions. This is particularly striking and worrisome with respect to the changing recommendation for the administration of mRNA vaccines.
These vaccines have been evaluated in clinical trials with two doses and should be administered after three or four weeks. There is currently no data demonstrating the consequences of postponing the second dose. NACI now recommends delaying the second dose for up to four months and, by the way, Canada is the only country to recommend this long delay. But there is absolutely no data to support this decision, and to do so without scientific evidence is equivalent to conducting a clinical trial without properly following up the participants and having their consent.
For the sake of transparency, the Government of Canada should make NACI's discussions public so that the actual data that was discussed to support the decisions and the outcome of the committee members' votes are known. The government should also require that all evidence taken into account in making the decision be made public at the time of the recommendation, not weeks later. We currently have no evidence regarding the consequences of delaying the second dose.
Finally, real-world data from the U.K. shows a differential response of individuals after the first dose of the Pfizer-BioNTech vaccine, depending on their age. From biological measurements carried out in the U.K., either from Dr. Gupta's laboratory or the REACT-2 study, some evidence shows that the first dose induces a good antibody response for people under the age of 69 years, but it is very different for the population over 69, reaching up to only 35% of people over 80 who will develop an antibody response, while all the people after the second dose develop an antibody response. There are therefore serious concerns about the extent of immunization of people over 70 years of age who are currently receiving only one dose in Canada.
I totally understand that the recommendations are made under the principle of equity in the context of limited supplies of vaccine doses. However, this recommendation may ultimately jeopardize the outcome of the vaccination campaign for the world population if expert opinions are wrong. The only good response to this situation is to do everything possible to make sure we get doses as quickly as possible, and to eliminate the propagation using sanitary measures during these times.
In conclusion, my take-home message is that Canadian policy on vaccine administration should evolve in real time, but only based on emerging scientific data. Of importance is that if the data is not available from countries that are leading the mass vaccination, Canada should consider mandating research to generate this data to support evidence-based decisions.
I thank you, and I will answer your questions
in English or French.
Liberal
Cole Pinnow President, Pfizer Canada Inc.
Thank you, Mr. Chair and members of the committee.
Bonjour. My name is Cole Pinnow, and I'm the president of Pfizer Canada.
It has been one year since this pandemic was declared. Since then, Pfizer-BioNTech successfully developed a safe and efficacious vaccine for the prevention of COVID-19 in record time, using a novel technology platform. To do that, Pfizer invested more than $2 billion at risk. We planned for success and scaled up a very complex supply chain. It requires more than 280 components, coming from 86 different suppliers, based in 19 different countries. We also established a highly innovative delivery system for a product requiring ultra-cold storage, and have shipped directly to hundreds of administration sites in Canada.
As we gather here three months after Gisèle Lévesque became the first Canadian to be vaccinated, I'd like to remind you about a small but important part of the effort it took to bring the first vaccine to Canadians as soon as science would allow.
In August we became the fourth country to complete an advance purchase agreement for the vaccine. We secured up to 76 million doses, while many other countries were also looking to lock in supply commitments. In September Health Canada introduced a rolling submission process that allowed us to file our vaccine data as soon as it became available. We initiated our application in October, and by mid-November we had made sufficient progress that a regulatory decision in December became a possibility. It wasn't until this time that we realized the need to accelerate both the initial delivery schedule and the provinces' readiness to administer the vaccine. This was not an easy task. Pfizer, PSPC, PHAC and the provinces all worked very hard to find a viable path forward so Canada could be ready.
As a result we became the second major country in the world to receive the vaccine when it arrived on December 14. This was almost two months earlier than originally anticipated. It's a tremendous accomplishment by so many, and we are very proud of this milestone achievement. Following the initial rollout, deliveries were temporarily reduced for three weeks as we worked on scaling up our Belgian manufacturing facility. It is important to note that this was a deliberate decision. We purposely chose to slow down production to make improvements that helped to increase our global annual capacity from 1.3 billion to two billion doses. Retooling our Belgian facility was the right thing to do: more vaccines produced, more countries receiving them and more people immunized.
Canadians benefited from these improvements as well. The complexity of both the scale-up of our manufacturing facility and our global supply chain is why we insisted that our contractual obligations for delivery be on a quarterly basis. This is not unique to Canada; Pfizer's delivery commitments around the world are on a quarterly basis.
We understand that Canadians want to know when they will be protected against the virus. We have gone above and beyond our original contractual obligations in two important ways to provide as much certainty as possible.
First, we share a rolling, weekly forecast as soon as we have confidence in its reliability. Today the public knows what to minimally expect from now through the middle of April.
Second, we are constantly working to accelerate our delivery. Canadians will now receive 12.75 million doses earlier than our original contract requirement. To date, we have supplied over 2.5 million doses, and have never missed a weekly delivery forecast. We remain confident that we will continue to be successful in delivering our forecasts going forward. By the end of this month we will have supplied 5.5 million doses. In Q2 we will have supplied 12.8 million doses, and in Q3 it will be 21.7 million. By the end of September, we will have provided Canadians with 40 million doses.
While we are optimistic about what this will mean as we emerge from this pandemic, we also need to reflect on how we can be better prepared for the next one. There are best practices and lessons to be learned. We have a unique opportunity to look back at Canada's pre-pandemic situation with clarity and work together to improve the life sciences sector in this great country.
Canadians have a new-found appreciation for the value of a resilient local biopharmaceutical industry. Past efforts to foster the life sciences sector had been undermined by detrimental policies of federal governments for more than a decade. If Canada wants to change course and succeed, it must put a stop to one-way consultations and engage in real dialogue with our industry. We stand ready to have this much-needed conversation and contribute to Canada's future.
As I end my remarks, I would like to reiterate that what has been accomplished so far is extraordinary. I express my sincere thanks to the 46,000 clinical trial participants, the hundreds of investigators, and the thousands of Pfizer and BioNTech scientists, clinicians and manufacturing professionals, many of whom have worked day and night. knowing that every moment matters.
Thank you.
I look forward to your questions.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Pinnow.
We'll start our questions at this point with Ms. Rempel Garner.
Please go ahead, Ms. Rempel Garner, for six minutes.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you. I'll be directing my questions to Mr. Pinnow.
Mr. Pinnow, I do have six minutes, so if you could be brief in your remarks, that would be wonderful.
Do you endorse your COVID vaccine as fully effective if the second dose is delayed up to four months?
President, Pfizer Canada Inc.
All the research to date on our vaccine has been done with two doses that have a schedule of 21 days. The recommendation that's been put in place by NACI, as highlighted earlier, in Canada is the only one in the world that is recommending an extended dose delivery.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you. I'll take that as a no.
I'm looking at an article that was published in The Lancet by a group of researchers from the University of Nottingham at the end of February. It's regarding your vaccine, particularly decisions related to extended dosing. This article argues that the clinical data, as well as real-life observational data based on evidence from Israel, did not support delaying the second dose of your vaccine past the recommended three-week interval.
Do you agree with this finding?
President, Pfizer Canada Inc.
The data that we've seen from a real-world evidence perspective that has been used to make arguments to extend the dose schedule has been with regard to much younger populations. The fact is that we don't have any data after two months to know what the impact of one dose will be.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
This article also states that, “Sub-optimal vaccination will create selective pressure facilitating the emergence of vaccine-resistant variants, which could result in a persisting pandemic.” This, of course, is in the context of a delayed dosing schedule.
Has your company conducted any research, or would it agree with the finding that an incomplete vaccination or a significantly delayed dosing schedule could potentially lead to the creation of vaccine-resistant variants?
President, Pfizer Canada Inc.
All of the research that we're doing today on variants—and again I'm happy to go into detail, if you'd like, on that subject—is with patients who have received two doses 21 days apart.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Did NACI consult your company prior to issuing its guidance to recommend delaying the second dose by four months?