Health Committee on March 8th, 2021

[The Vice-Chair, Conservative, Michelle Rempel]

I call this meeting to order.

I note that everyone has the right to speak in their own official language. With regard to all the normal housekeeping things the chair normally says, I don't have a script.

Mr. Clerk, I will turn it to you to start witness presentations.

[The Clerk of the Committee, Mr. Jean-François Pagé]

Dr. Fisman will be first, for up to six minutes.

[The Vice-Chair, Conservative, Michelle Rempel]

Thank you.

Dr. Fisman, please go ahead.

[Dr. David Fisman, Professor of Epidemiology, University of Toronto, As an Individual]

Thank you so much.

Honourable members of the committee, I'm pleased to speak to you today. It's been approximately one year since I last appeared before you, and it has been a year like no other. While we have had many surprises, perhaps most surprising to me is the degree to which this pandemic has met our pre-pandemic expectations of the origins and course of such an event.

As predicted, a virulent pandemic emerged at the human-animal interface when an animal virus crossed the species barrier. Our fear is focused on a pathogen that combines virulents and transmissibility, and SARS-CoV-2 has done that par excellence. The contours of this pandemic, both in terms of timing and societal disagreement around masks, business and school closures, also directly echoed the 1918-19 influenza pandemic.

I'm sure that many of you, like me, wish that we were further along in vaccinating all Canadians against SARS-CoV-2. As with the control of the pandemic itself, Canada is neither at the front nor the back of the pack. We are getting there. Long-term care facilities across the country are largely vaccinated, and that has led to a marked reduction in daily deaths from SARS-CoV-2. However, as a friend recently remarked, Canada doesn't have a “let's finish in the middle of the pack” program for the Olympics. We have an own the podium program. We have the smarts, and the resources to be at the front of the pack.

Better performance in a crisis like this depends on strong systems, which unfortunately can't be created overnight. As they say, it's hard to build the airplane when you're trying to land it. Public health funding in Canada may be a victim of its own success. When public health systems are functioning well, they are silent, but they allow other sectors of our economy to thrive.

Unfortunately, the conditions that created our current pandemic will not disappear when this is over. Environmental degradation, climate change, illicit trade in wildlife, and risky laboratory work are all likely to continue, making a recurrence of a similar event fairly likely. As such, I'd like to look forward rather than backward, and talk about what we might build out of this experience in order to protect Canadians in the event of a future severe pandemic, with a focus on vaccination.

Vaccines are the door out of the current crisis for the simple reason that it isn't the virus that creates a pandemic, but rather widespread susceptibility to a new virus. Vaccines remove that vulnerability. The frustrations related to COVID-19 reflect weaknesses in two major areas, neither of which appeared overnight, and neither of which can be resolved with a snap of the fingers.

First, vaccination data systems across the country are weak or non-existent. Second, while we have a rich history of vaccine-related innovation in Canada, the path from innovation to commercialization seems to be a challenging one, and our ability to manufacture vaccines in Canada is limited.

In discussions with colleagues, it has emerged that notwithstanding spending around half a billion dollars annually on vaccines, we lack national or even well-functioning provincial appointment systems, vaccine registries and adverse event surveillance systems. We even lack common terminology across provinces to create such systems. These systems are now being built perforce during a national crisis. They need to be strengthened, integrated and maintained when the pandemic is over, both because they'll allow us to immunize more efficiently and effectively in peacetime, and also because they'll be a key strategic asset when the next pandemic occurs.

Similarly, delays in acquisition of vaccine supply underscore the importance of building strong manufacturing capacity for vaccines here in Canada. The era of vaccine companies as university-owned entities or Crown corporations like Connaught is long gone, but we have tremendous innovation in the vaccine space in Canada.

The Pfizer-BioNTech mRNA vaccine may represent a new paradigm for partnerships between smaller companies and global vaccine manufacturers, and could provide a pathway for Canadian innovators too. I'm also delighted to see that we will soon be manufacturing the Novavax COVID-19 vaccine here in Canada.

A key advantage of partnering with global firms relates to the global nature of communicable diseases. For example, it's important for companies to trial vaccines in other countries where novel SARS-CoV-2 variants are emerging.

In closing, this pandemic has made it clear that strong public health systems and vaccines are strategic assets that need to be actively maintained for the protection of Canadians, just as we would maintain a strong and competent military. As with the military, we don't want to be strong so we can get into fights, we want strength so we can protect ourselves from threats like SARS-CoV-2 that are likely to continue to emerge in the years ahead.

[The Vice-Chair, Conservative, Michelle Rempel]

Thank you, Dr. Fisman.

Dr. Weiss, you're up next.

[Dr. Karl Weiss, Full Clinical Professor, Faculty of Medicine, Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, As an Individual]

Thank you for inviting me, honourable members of Parliament. I'm very happy to be in front of you this morning.

I don't have a formal presentation to give you this morning but I gave a few slides to the clerk. I'm sure he will be able to send you my presentation where you will have some data to cover what I will say.

Talking after my colleague Dr. David Fisman, whom I know well, I completely agree on many different topics and I want to underline a few important points.

I would summarize that Canadians did very well throughout this crisis. I think we have to be very proud of ourselves because if you look at all the G7 countries in terms of rates and mortality we're probably better than many others except Japan, but Japan is a very specific case. If you compare us to the United Kingdom, France, Italy, Germany and the United States, we did very well as Canadians. People were very disciplined throughout the crisis in general.

In terms of our global response as a country we didn't do that well. This is where we have a few challenges for the future, and these types of challenges will happen again. We're in a world where emerging infectious diseases will be on the menu for the next century. We travel more, and we have many ecological issues in deforestation, which is a big thing for emerging infectious diseases, because you have these viruses stuck in the middle of the Amazon jungle. Until you start destroying the forests you won't be able to see them.

We can travel around the world like never before. We're a country where one of its health.... This population comes from all over the world. Because of this, we're travelling all over the world. I think it challenges us in the future that we should have a system in place to be able to limit the impact of these emerging conditions.

There are a few things here.

The strength of our system is that we have federal and provincial levels. This is also a weakness of our system because we had a lot of bickering between the different provinces and the federal government in terms of who is responsible for what.

Personally, not as a physician, but as a Canadian, in the future I would expect my federal government to step in very quickly and use all its power to try to contain a pandemic like this. For example, we had great military forces that were deployed to a certain point. We had the experience of having our armed forces in Quebec, but having the potential and the availability of our soldiers helping the Canadian population with logistics whenever possible would have been great. I think there are examples around the world in immunization where the army played a very important role in logistics.

Closing the border was also a big thing. I understand from a political standpoint it was very difficult. It was probably the biggest challenge we had as a nation since the last world war. From that perspective for all of us who were born after 1945, and even for the others who were probably children during the Second World War, there hasn't been any challenge as big as this one in our lifetime. It's extremely difficult to go from an ordinary life to an extraordinary life very quickly.

From that perspective, having in place all the measures to be able to close the border quickly and to implement certain rules quickly in isolating people, quarantines, etc., will be very important.

The biggest challenge, and it's our only way to get out of this, is the reindustrialization of the Canadian economy, which is mostly for medical equipment. We had to struggle for masks, ventilators and tests, very simple things. We're testing hundreds of thousands of people every day in this country, but you have to realize that all the equipment needed for the tests is very difficult to get. Much of it is coming from abroad; sometimes you need a plastic pipe head, which was not available in this country, and we had to compete with the rest of the world to get them.

I think that strategically a country like ours should be able to muster this in the future and make sure we won't be caught a second time without an industrial base to be able to do this.

The second thing which is really important, and I think I will—

[The Vice-Chair, Conservative, Michelle Rempel]

Dr. Weiss, I'm just going to let you know you have about 45 seconds left.

[Dr. Karl Weiss]

There is a second thing that is very important for me. I will just emphasize what David just said: it's really the vaccine capability of this country. We lost part of our capability. We just have to rebuild it and regain it. I think that will be very important for the future not just for infectious conditions, but also because mRNA vaccines will be used for cancer at one point, and this is why it's important.

Thank you very much.

[The Vice-Chair, Conservative, Michelle Rempel]

Thank you so much.

Just as an FYI for colleagues, per Dr. Weiss's comments, he has presented some slides to the clerk. They haven't been translated yet, and it's my understanding that they will be translated and then circulated in both official languages.

I notice that Ms. Ravon has joined us. I'm very much looking forward to your testimony on International Women's Day. You have an inadvertent female chair at the moment. With that, six minutes go to you.

[Lauren Ravon, Executive Director, Oxfam Canada]

Fantastic. Thank you very much. Happy International Women's Day to you all.

Thank you for the invitation to appear on behalf of the People's Vaccine Alliance. As you may know, Oxfam is one of the founding members of this growing movement of health and humanitarian organizations, past and present world leaders, health experts and economists. We're calling for a COVID-19 vaccine to be made available for all people in all countries and free of charge.

We know that COVID-19 knows no borders and has impacted everyone's life. Canadians from coast to coast to coast are hurting. But we also know that the pandemic has hit certain groups harder than others. Here in Canada, Black, indigenous and racialized women, women with disabilities, and immigrant women have been hardest hit by the virus. In many cities, they have the highest infection rates. This is because so many of these women are frontline health care workers or work in what we now recognize as essential jobs. This is why Oxfam has labelled the coronavirus the “inequality” virus, to emphasize just how much COVID-19 is deepening and exacerbating existing inequalities.

The pandemic has demanded interventions on a scale and scope not seen in decades. Canada has invested unprecedented levels of resources to provide a safety net for people here in Canada, but it has also offered significant support to help developing countries weather this storm. This includes close to $940 million to support equitable access to COVID-19 tests, treatments and vaccines through the WHO access to COVID-19 tools accelerator. This funding also includes $325 million for the COVAX advance market commitment stream, which aims to help vaccinate 20% of people in 92 low- and middle-income countries, especially the most at-risk groups.

Unfortunately, at current trends, nine out of 10 people in low-income countries will miss out on a COVID-19 vaccine this year. Estimates show that poorer countries will not have widespread vaccination programs in place until 2024. We need to do better. The longer the virus is around, the more likely it is to mutate, making current immunization efforts ineffective.

The WHO initiatives that Canada is supporting are important. Unfortunately, they do not tackle the global problem of vaccine shortages. They are also undermined by wealthy countries cutting bilateral supply deals that drive up prices and limit supplies. Our best chance of us all staying safe is to ensure that COVID-19 vaccines are available for us all as a global common good. This will only be possible if we change the way in which vaccines are produced and distributed. Pharmaceutical companies need to allow COVID-19 vaccines to be produced as widely as possible by sharing vaccine technology free from intellectual property rights. We need to maximize production so that enough doses are available for the world to achieve herd immunity.

What's fantastic is that Canada can help end the scramble for vaccines. Canada became co-chair of the COVAX advance market commitment engagement group this past January. In her role as co-chair, Minister Gould can strengthen COVAX by pushing for increased transparency and inviting developing countries and civil society representatives to decision-making spaces. Canada should refrain from procuring vaccines from COVAX at this time. For many low-income countries, COVAX may be their one and only chance of receiving vaccines this year.

Ghana and Ivory Coast received their first vaccine shipments this past week through COVAX. This is worth celebrating as a first step to ensuring that their health care workers have the protection they need to do their jobs safely. Unfortunately, close to 80 other countries have yet to receive a single dose.

The world needs more vaccines, and fast. This week Canada has the opportunity to change the course of the pandemic. A waiver on trade-related aspects of intellectual property rights, otherwise known as TRIPS, is being brought to a vote at the World Trade Organization. Spearheaded by South Africa and India, and supported by more than 100 countries, this waiver would be a game-changer for increasing vaccine supplies, as it would allow countries with the manufacturing capacity to make COVID-19 vaccines.

We hope to see Canada vote in favour. This pandemic has shown us how interconnected we all are and how vital it is to have international co-operation and solidarity. By voting in favour of the TRIPS waiver at the WTO this week, Canada can help stop the pandemic in its tracks.

Thank you on behalf of Oxfam and the People's Vaccine Alliance for the opportunity to appear today.

[The Vice-Chair, Conservative, Michelle Rempel]

Thank you for your time and your work.

With that, I will turn to Ms. Demarais, our last witness in this panel.

Ms. Demarais, you have six minutes.

[Agathe Demarais, Global Forecasting Director, The Economist Intelligence Unit Limited]

Thank you very much.

Honourable members of the committee, I'm very pleased and honoured to be here today. My name is Agathe Demarais. I'm the global forecasting director at The Economist Intelligence Unit.

In January, we published a study presenting our forecasts for global coronavirus vaccination timelines around the world. I think this is the study that Lauren Ravon mentioned in her testimony. These projections presented the time when each country around the world can expect to have vaccinated 60% to 70% of its population.

There are three main conclusions that I'll present now before digging a little further into the data. The first conclusion is that vaccination will take a lot of time. Vaccinating the majority of the world's population will take until at least late 2022, and for many countries, the timelines will stretch until 2024 if vaccination happens at all.

The second conclusion is that production is the main bottleneck around the world. We studied seven criteria to make our timelines, and production was always the one that made timelines slip.

The third conclusion is that this poses two main risks. The first risk is for the global economic recovery because some countries will recover faster than others as they will have vaccinated faster than others. The second risk is obviously that while not every one is vaccinated, new variants of the coronavirus pandemic can emerge and could take us back to square one.

First, why did we do this study and what was our methodology? Until recently, the main variable for political and economic forecasts that we do at the EIU was the course of the pandemic. That's not the case anymore. Now it's all about global vaccination timelines.

What was our methodology? Briefly, we took seven factors into account. The first one was production. As I mentioned, it's the main bottleneck because 15% of the world's population have pre-booked around half of the supply of coronavirus vaccines that will be produced this year.

The second factor was supply deals.

The third factor was logistics with a special focus on two issues. The first issue was transportation, which is going to be very tricky because normally vaccines are shipped via passenger planes but there's no travel anymore because of travel restrictions. The second issue was the cold chain, because some countries do not have the required cold chain to use some of the vaccines that require ultra-low temperatures.

The fourth factor was the availability of health care personnel to administer the vaccines. This is going to be a bottleneck in some countries, for instance, in Asia.

The fifth factor was financing. It is crucial for many poorer countries.

The sixth factor was vaccine hesitancy, which is especially acute in some countries like France, Japan and Argentina.

Finally, there were some local factors because some countries simply do not want to vaccinate. This is the case in Tanzania, for instance.

The second thing that I wanted to mention is the main takeaways from our study. We mapped four different categories of countries. The first category is the fastest countries with timelines stretching into late 2021, so late this year. We have exceptionally fast countries such as Israel, the United Kingdom, Serbia and the Gulf countries, and other very fast countries in the EU, the U.S., Switzerland, Hong Kong and Singapore, for instance.

The second category of countries have timelines stretching into mid-2022. This is still very good by global standards. These are other OECD advanced countries such as Australia, Japan and South Korea, or middle-income countries that have production capacity such as Brazil, Russia and Mexico.

The third category of countries is where we found most middle-income countries, and India and China, with timelines stretching into late 2022.

Why are India and China taking until late 2022? It's because of the sheer size of their population, which is going to present a big challenge, and also because these countries are exporting vaccines in large quantities so they will find tensions between supplying their domestic markets and supplying exports.

Finally, the fourth and last category, where the majority of the world's population finds itself, is timelines stretching into 2023 and beyond, if vaccination even takes place. This is the rest of the world, mainly low-income countries. It includes most countries that will depend on COVAX, which will cover only 20% of the population of eligible countries with timelines that are non-binding and subject to change. There's a real risk in these countries that vaccination will not take place, because in some of these developing countries, governments could find that vaccination could be too costly or too difficult.

Finally, what does that mean for the global economic recovery, which is something that we forecast at the EIU? It will start from the third quarter of 2021, so the third quarter of this year, because that's the time when the U.S., Europe and many of the OECD countries will have vaccinated the bulk of their populations. China is the engine of global growth but vaccination timelines can stretch further because the pandemic is under control in China and so there is no real rush to vaccinate, which is quite different from the situation in many western countries.

That being said, the global economy will recover to pre-coronavirus GDP levels only in late 2021, so it will take time, and this forecast masks wide disparities. It's artificially boosted by China, where we forecast that growth will boom this year. For the U.S. and the EU, we will see a recovery to pre-coronavirus levels only in 2022 and in Japan in 2023. In emerging countries, timelines will be much slower for recovery, which reflects the slow vaccination timelines that we've just discussed and the lack of fiscal space to launch stimulus plans.

This poses two main risks, finally, for global economic recovery. The first one is that global vaccination timelines could slip even further, which would delay the recovery. The second one is, as I've mentioned, that, while not everyone is vaccinated, we could see new variants emerge that could prove resistant to vaccines.

Thank you very much for your attention and for having me today.

[The Vice-Chair, Conservative, Michelle Rempel]

Thank you very much to the witnesses.

I believe our chair has figured out how to get into the meeting.

[The Chair, Liberal, Ron McKinnon]

Yes, I believe so.

Thank you, Ms. Rempel Garner.

[The Vice-Chair, Conservative, Michelle Rempel]

Chair, I will pass it over to you on this International Women's Day, which seems apropos.

It will be Mr. Maguire from the Conservatives for six minutes.

[The Chair, Liberal, Ron McKinnon]

Thank you, indeed.

Congratulations to everyone on this International Women's Day.

Please, Mr. Maguire, go ahead for six minutes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Chairs.

I want to thank the witnesses for their presentations today, which were most relevant and interesting to the situation that's facing us here right now.

To Ms. Demarais, you've done this huge study, and we have an awful lot of.... You're talking there about recoveries in 2021 for China, 2022 for the U.S. and 2023 and beyond for the emerging countries.

With regard to the forecast of the pandemic's long-term impacts on things more relevant, probably in Canada but probably relevant to other areas of the world as well, is commercial real estate. Do you know how the pandemic has so far impacted some of these commercial real estate markets around the world? I'm looking at a very relevant question to follow that up with.

[Agathe Demarais]

Mr. Chair, I would like to reply that, yes indeed, the pandemic has had an impact on commercial real estate. I'm afraid I haven't prepared anything on the subject today, so I would be hard pressed to give a definitive answer. I apologize about that.

[Larry Maguire, Conservative, Brandon—Souris, MB]

That's fine. I guess I'm looking at major concerns about working people, people working from home and the impact of that on the economy. I don't know if you have anything in that regard.

You're looking at some pretty different timelines in different areas of the world as far as the economic recovery goes, but the change in people being able to work at home, is that something that you can comment on? How that will impact the real estate market is basically what I'm looking at, whether it's commercial or even households and the changing of home values.

[Agathe Demarais]

To answer your question, I think that the question is about the future of cities. I would phrase it that way, with commercial real estate, perhaps with some offices, downsizing space. I think this is a possibility, but at the same time, we can see that things could go in any direction. We could see that people would want to go back to the office. It's certainly the case in some countries; it varies country by country. In other countries, we've seen people who have fled cities try to work remotely from other locations, so it's going to be a case-by-case situation.

In terms of the timelines for recovery, as you've mentioned, we're looking at early 2022 for the U.S. and Europe to go back to pre-coronavirus GDP levels, so it's going to take time. Canada is in the same timeline.

I would say that, so far, it's a bit too early to make definitive forecasts about the future of work. It's a very open debate, I would say, but it's something that we'll certainly monitor very precisely.

[Larry Maguire, Conservative, Brandon—Souris, MB]

To you and Ms. Ravon as well, in regard to the number of vaccines getting out to people, you were saying that production is always one of the seven criteria and one of the very key issues that allows timelines to slip. Can you comment further on the impact? Even if a country like Canada, with as small a population as we have, gets completely vaccinated, if these other areas of the world aren't vaccinated until 2023 or 2024—and I noted you said emerging countries if at all—this virus is still very alive and well across the rest of the world. How do we deal with that? What's the best way to deal with the impact of that?

[Lauren Ravon]

That's a great question, and I think there are two parts to the answer.

One is just on the medical side of things. We know that the disease is mutating, that the longer we wait to vaccinate everyone, the more we all are at risk in terms of the changing variants making us less safe here in Canada. Even if we do get vaccinated, if the world is slow to vaccinate the entire population, we are at risk.

Then perhaps even more importantly, as long as the global economy doesn't recover, our economy won't recover. Things like travel will remain disrupted; global supply chains will remain disrupted; and also, perhaps most importantly, the global fight against poverty will continue to go backwards. We are losing ground day by day.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Ms. Demarais.

[Agathe Demarais]

I think the main risk, in addition to what Ms. Ravon has said, is that a number of emerging countries could well lose de facto motivation to vaccinate if they find that it is too costly or too tricky or if production remains a big bottleneck. I think this is the main risk.

[Larry Maguire, Conservative, Brandon—Souris, MB]

How should Canada best deal with this?