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.
Global Forecasting Director, The Economist Intelligence Unit Limited
I do not believe that it is my place to make recommendations to Canada. I think that our study was to look at global vaccination timelines.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
For a country like Canada, then.... We're connected to the United States. We're so close here. We're part of a major continent in the world. Do you have anything in regard to...? I don't mean a recommendation—
Conservative
Executive Director, Oxfam Canada
I think there are two things.
I think what we're already doing, supporting COVAX to get vaccinations out and quickly, is a great first step. The second step, as I mentioned, is waiving intellectual property rights, because right now time is of the essence. We just need to ramp up production. There is no other way around it, and until we open up intellectual property rights on these vaccines, we won't be able to ramp up production to get people vaccinated.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
Okay.
Ms. Demarais, the pandemic has caused many countries all over the world to run deficits. We know that it's costing our economies and our treasuries hundreds of millions of dollars each day.
What are your predictions with regard to inflation and currency devaluations becoming a problem soon, if not already, here?
Global Forecasting Director, The Economist Intelligence Unit Limited
Our forecast is that the main risk to the global economy—obviously there is the coronavirus pandemic and everything related to vaccines—is having a spike in inflation. It's not our baseline scenario, but if inflation were to spike because of a spike in global demand once the global economy recovers, that would be a definite risk because it would make repaying debt very tricky. At the moment that's not our baseline forecast, but it's certainly something that is worth monitoring.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Maguire. I believe that's your time.
Mr. Van Bynen, please go ahead for six minutes.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
Thank you, Mr. Chair.
I want to start by thanking our witnesses for joining us today. I also want to wish everyone a happy International Women's Day.
Dr. Fisman, I share with you the view that we need to learn from this situation and we need to start thinking about what we should be doing, working forward. You're based in Ontario and you've been working with the provincial governments on the vaccine rollout. Can you talk about the work that provincial governments need to do, from your perspective, in order to ensure a rapid and efficient vaccine rollout?
Professor of Epidemiology, University of Toronto, As an Individual
Just to be clear, I don't have a role on the Ontario vaccine task force at all. I am on the science table in Ontario and the modelling table, and I can give you my perspective more as someone who is looking at data rather than designing new systems.
Professor of Epidemiology, University of Toronto, As an Individual
I can also possibly make a comment as a physician.
I think, to my mind, we're doing some good stuff. The marvellous observation over the last month or so is we've had long-term care facilities in Ontario serve as a major source of death during this pandemic and the Pfizer vaccine and then the Moderna vaccine have basically shut that down. Our science table has a brief that came out today looking at the impact of these vaccines in long-term care and it's nothing short of spectacular.
If there's a major failing that I see in Ontario that's holding us back, and I think we are starting to fail to keep up with vaccine supply as it comes into the province, we have about 8,000 or 9,000 family doctors in this province who vaccinate a few million Ontarians against influenza every flu season. I'm aware of the logistical issues with the mRNA vaccines, but we're starting to get into vaccines that don't have the same extreme cold requirements for storage. I think family doctors know how to do this. They know their patients. They know how to prioritize and how to get folks vaccinated.
I think there are some infection control concerns in terms of individual people's offices and not all doctors feel comfortable having a large crowd of folks pass through at this time. But I do think that as we try to do something new, we have to use the tools that we already have in our tool box. We do have this group of individuals who are very, very good at vaccinations who have been underutilized to date, so I hope that changes.
The thing I'm proudest of in terms of the Ontario science table, and it's brought me along a little bit.... We see this every year with the influenza vaccines. Usually the dilemma with vaccinations is that the vaccines are least good at protecting the individuals you most want them to protect. Most deaths from influenza each year occur in individuals over age 65, for whom traditional influenza vaccines—we have some better ones now—arguably have not worked at all in that demographic. We've directly tried to protect individuals with vaccines that are very unlikely to work in that age group, whereas we could probably protect them more effectively by going for the herd, as the flu vaccines work in younger people.
We don't actually have that dilemma with COVID vaccines, because the mRNA vaccines in particular are so potent that we can directly protect individuals over age 80, over age 70, individuals with underlying medical issues, by directly vaccinating them. To some extent, this decision has been a bit of a no-brainer in terms of who you vaccinate first. It's older people, and I think you see that in other countries.
The modification to that which has come out of our science table is this observation that about 90% of all of our COVID cases come from 10% of our postal codes in Ontario. Those have been overwhelmingly postal codes that are more densely populated urban areas, lots of people of colour, lots of new Canadians, lots of folks involved in essential work. What came out of the science table, and I think the province is now following this, is an attempt to sort of front-load, in addition to prioritizing older people and folks with underlying medical conditions, vaccinations in some of these zip codes that have been really the hardest hit, to try to get some of those herd effects as well.
I think it's a neat piece of nuance. I realize it raises equity concerns in other areas where people have said, “Hey, what about us over here? We're vulnerable, too.” These are hard decisions with a scarce resource, and I think they did pretty well with that.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
Yes, a lot of these decisions are data-based. Dr. Fisman, I'm hoping you can expand on the tools that are available to the provinces and territories, such as testing, contact tracing, public health measures, that would get us through this crisis, and the importance of data and how data can help lead the decisions that we need to effectively counter the effects of this pandemic.
Professor of Epidemiology, University of Toronto, As an Individual
Right. Increasingly, I think, public health has become a data-focused discipline. I mean that how we understand processes, how we see them, really depends on the data we have. It's unfortunate, I think, that in my province, Ontario, we have a bit of a track record where we've sunk billions of dollars into data systems and famously have had very little to show for that. I think that is sort of a caution to us if we say, “Let's just throw a bunch of money at this and build some good data systems.”
We have needs on a bunch of different fronts. In terms of public health surveillance systems, we could really use some upgrades that make surveillance systems interactive, to have a kind of crosstalk across the country, a shared vocabulary, and relatively user-friendly data systems and data systems that are actually linked into.... As you know, we have national health care in Canada. It would be great if we could actually have interactivity between our public health data system and our health care data system.
On the subject of vaccines in particular, because that's what I've been thinking about in heading into this meeting, we are really patchy, and to date we have very little that has been constructed. As far as I know, the only province in Canada—and I hope I'm right about this—that has an adult vaccine registry is Prince Edward Island. I think that's it. We really don't know.
As I mentioned in my remarks, we spend half a billion dollars annually on vaccines, but we actually have no means of tracking who got them or of linking back to health records so that we could look to see whether if you're vaccinated you're less likely to be hospitalized and so forth. We're really struggling in terms of appointment systems. We don't have a good national, nimble system to monitor vaccine adverse effects, which is a really big issue with brand new vaccines.
Liberal
Professor of Epidemiology, University of Toronto, As an Individual
Sure. Sorry.
Liberal
The Chair Liberal Ron McKinnon
Thank you very much for that excellent information.
We'll now turn to Mr. Thériault.
Mr. Thériault, you have the floor for six minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
I want to thank the witnesses for taking the time to come and give us their presentations, which are very enlightening and relevant.
We're dealing with a global pandemic. The presentations given by Ms. Demarais and Ms. Ravon speak for themselves.
Professor Fisman and Professor Weiss, you are scientists. You spoke about the need to establish a more centrally coordinated approach. However, shouldn't this have been done on a global basis in the first place?
The vaccine protectionism that we're facing has led to a vaccine race. The findings of Doctors Without Borders, Ms. Ravon and Ms. Demarais show that this global pandemic is forcing us to review our methods. Variants will continue to pose a threat and may take us back to square one. This is a long-standing issue in third world countries, two-thirds of which are excluded.
Professor Weiss and Professor Fisman, I want to hear your thoughts on this.
Full Clinical Professor, Faculty of Medicine, Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, As an Individual
Mr. Thériault, I'll answer you as best I can.
First, we're dealing with a virus that will persist. In other words, because the coronavirus has a non-human reservoir, it won't necessarily be eradicated. We'll probably have to live with the virus for a long time. This is different from smallpox, which was eradicated in 1977 through global vaccination.
We'll also be facing a situation where we'll need to administer flu-like vaccines on a regular basis. It's possible that we'll need to vaccinate people every year or two, worldwide, to protect them from new variants.
You must also understand that the variants aren't necessarily unexpected. The variants are a way for the virus to adapt to humans and to improve itself, so to speak. A variant isn't necessarily worse. We don't see all the failed variants. It's a bit like a cake. We don't see all the failed recipes, only the successful ones. This is somewhat the case with variants, which show the adaptability of the virus.
Obviously, the World Health Organization, like many large organizations, dropped the ball somewhat. The World Health Organization is subject to all sorts of political pressure. At first, the information on the extent of the pandemic wasn't very clear and straightforward, including the information on what happened in China. Later on, we learned a bit about the extent of the pandemic. From a purely technical perspective, we received information about the sequence of the virus from Australia, where a laboratory isolated the virus using people who had come from China. We can't rely too much on international organizations to show complete transparency, since the states that make up these organizations aren't transparent.
In Canada and Quebec, we must protect ourselves so that we have the pieces in place to protect our population as best we can under the circumstances. Of course, we can work with other countries. We must do so when we don't have the capacity to produce vaccines, for example.
For Canada, we must have a strong detection system. For example, we have a very good system of provincial laboratories. We also have, in Winnipeg, a national laboratory whose capabilities are world-renowned. However, in Canada, we must develop some sort of external warning and monitoring system to quickly identify threats and implement measures to counter them.
We're told that we must build the plane as we fly. I think that everyone agrees that, at the start of the pandemic, we were caught off guard on all fronts when it came to implementing measures to deal with the virus effectively.
We could discuss this matter at length. Let's just say that we'll need Canadian vaccine development and production capacity to meet the needs of the entire population. On a practical level, we're in a global competition. Both states and the European Union, which is a group of states, want to keep vaccines for themselves. China and India also manufacture their own vaccines.
In addition, there are geostrategic considerations involved in this situation, such as giving vaccines to poor countries when the vaccines are likely being used as a bargaining chip.
In Canada, where we have the expertise, we certainly have no choice but to produce these vaccines. We could do so together with other countries.
Bloc
Luc Thériault Bloc Montcalm, QC
It's about rebuilding our production capacity with our experts, which we were unable to do at the start of the pandemic.
You have been very critical of AstraZeneca. In terms of the use of vaccines, do you advocate for a differentiated vaccination by age group?
Are you still as critical of AstraZeneca, when studies continue to come out and change with regard to vaccine effectiveness?
Full Clinical Professor, Faculty of Medicine, Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, As an Individual
I've been critical because our current data shows that the AstraZeneca vaccine is potentially less effective than the other two vaccines, which are messenger RNA vaccines. That's the protection data.
The AstraZeneca vaccine isn't a bad vaccine. However, you must know that it has been much less widely used than the other vaccines. One issue right now is the perceived safety of the vaccine by some segments of the Canadian population.
We know that messenger RNA vaccines have been given to over 80 million people. We haven't seen many safety issues. That's one way to encourage vaccination.
There have been many technical issues with the AstraZeneca vaccine. We've heard that it isn't as effective in people over the age of 65. That's true. The vaccine is also less effective against the South African variant. This has been shown in studies.
I don't want to go into too much technical detail. If we didn't have any alternatives to the AstraZeneca vaccine, I would be the first to say that I'm willing to receive it. I wouldn't have any particular issue with receiving the vaccine. However, given that other vaccines seem better and more effective, if I had a choice of vaccine, I would opt for the more effective one.
The best example is Israel, which has vaccinated over 80% of its population with the same vaccine and has seen a significant decrease in severe cases, especially among seniors.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Weiss.
Thank you, Mr. Thériault.
We will now go to Mr. Davies.
I will give you a little bit of extra time also.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
Thank you to the witnesses for being here.
Ms. Ravon, Oxfam Canada is on record as saying that “Canada should use its leadership to encourage G7 countries to stop supporting pharmaceutical corporations monopolies on COVID-19 vaccines.” Oxfam has stated that “Breaking up the monopolies of the big pharmaceutical companies is the quickest, fairest and most effective way of boosting vaccine production so that countries are not forced to compete [for scarce and limited] doses.”
There's an important vote coming up this Wednesday at the WTO. Has the Government of Canada indicated whether it will support the proposed temporary IP waiver at the upcoming WTO council on trade-related aspects of intellectual property rights?
Executive Director, Oxfam Canada
I obviously can't speak for the Government of Canada. All I can say is that we're hoping to see Canada take a strong stand to support the waiver of the TRIPS. This is because ultimately it's a matter of scale. We need to be producing vaccines everywhere we can, in every country we can, in every lab that can produce them. At this moment in time, if we're dependent on some pharmaceutical countries, then vaccination could be delayed for three or four years, or even, as Madame Demarais said, some countries could simply decide to forego vaccination.
If you look at some of the vaccines today, it costs almost $40 for a two-dose vaccine. Poor countries are not going to be able to pay that for their entire population, so we're hoping that Canada will say yes to a temporary waiver.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Offhand, do you have any idea, Ms. Ravon—or maybe even you, Madame Demarais—generally what percentage of the investment that produced COVID vaccines was publicly financed?