Health Committee on March 11th, 2021

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

Thank you, Mr. Chair.

I may share some of my time with some of my colleagues who have questions as well.

Dr. Quach, you indicated that you were looking at.... You are an independent committee, there is no doubt about that, but your decisions are public. You are experts in these fields, and the public knows that. Do you not feel there's an expectation among the public to wait with bated breath for every word you say? The contradictions here have certainly left skepticism among the Canadian public as to what they should do in regard to vaccines. We've talked about vaccine hesitancy. Can you elaborate on that?

[Dr. Caroline Quach-Thanh]

Yes, absolutely.

We have to realize that Health Canada will authorize a vaccine or a medication, and it's not the first time the clinical guidelines will differ from what has been authorized. In this particular case, Health Canada deemed the vaccine was safe and efficacious enough to be used in all age groups, which is its decision. What we had in terms of data did not make us comfortable enough at that point to allow for the use of AstraZeneca in those aged 65-plus. I realize that since then real-world evidence has emerged. As I said, we met yesterday to review that data.

It's possible that at points in time we will differ in opinion, but I would ask the members of this committee if they think it would be preferable that we would have erred with Health Canada, even though in our opinion we weren't ready to make that recommendation.

We make recommendations based on multiple issues, including looking at other vaccines that are available. As I said, we had two mRNA vaccines that were highly efficacious in those aged 65-plus, and our mathematical modelling showed us that what we had proposed was a recommendation that was completely sane, and that's what the committee was comfortable with.

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

The other side here too is that we were talking earlier about the time frame, and that a few days can make a difference and change the advice. This was two days, and such conflicting views within that two-day period. I know that science has been extrapolating right through this whole process for a year now, but for the public to absorb the fact that the change took place before the AstraZeneca vaccines even got here.... Can you tell us why?

[Dr. Caroline Quach-Thanh]

Had we known that Public Health England was going to publish its real-world evidence the next day, showing such a high effectiveness in preventing hospitalization, we would have waited an extra day. It's easy when you look back in the—

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

Would that have changed your mind?

[Dr. Caroline Quach-Thanh]

As I said, we have looked at that, and the recommendations will be updated, but you don't know what's coming in front of you. It's impossible, moving forward, so at one point in time you have to say, “These are the data we had.” We had said to the Public Health Agency of Canada that we would aim to get a recommendation out for AstraZeneca within days of Health Canada's approval, because of the fact that vaccines were going to be used in Canada, and therefore provinces and territories needed to know how to use them.

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

You would have had information before you that indicated that some of these products hadn't been used in certain sectors of society, in certain age groups, certain races, people with health concerns, and other areas. Why would the recommendation come out for the vaccine not being used on anyone over 65 if you knew there were other areas that hadn't had trials?

[Dr. Caroline Quach-Thanh]

I'm not sure I'm following your question.

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

Well, there wasn't efficacy done in some of the younger age groups. Certainly they were saying you shouldn't use it on anybody over 65, but—

[Dr. Caroline Quach-Thanh]

We had data on the 18 to 64, with a confidence interval that did not include zero, so I am not sure what you're referring to.

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

You didn't have it, but then you know there were conflicting views within a few days of the decisions that you were making.

[Dr. Caroline Quach-Thanh]

The fact that Health Canada and our recommendations do not align is not conflicting views, to my sense. Health Canada is looking at data with a different paradigm. We are looking at the data knowing what else we have in our portfolio. Health Canada is not ranking one product versus the other; we are.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

We go now to Mr. Fisher.

Mr. Fisher, please go ahead for five minutes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair.

At the start of every time I get a chance to speak at committee, I always thank the witnesses, but I have to tell you, I am so appreciative that we have experts and scientists like the people on this panel, the people at Health Canada and the people at NACI, who are making these decisions and these recommendations for provinces and territories, and not politicians. My gosh, what a state we'd be in. Thank you so very much for all that you are doing.

We talk about NACI, and we heard that they have been independent expert advice providers for over 50 years and have been appreciated by provinces and territories for 50 years. This is absolutely....

I want to go to Dr. Quach-Thanh.

When it comes to the health and safety of Canadians, we know that we need to rely, as I said, on experts in science. It's imperative that medical decisions be made by health professional experts, as I said, and not by politicians. Canadians need to know that the vaccines they are taking are safe and that the recommendations made for their use are based on what is best for them and what is best for Canadians across the country.

Dr. Quach-Thanh, can you talk just a little bit more about the role of the national advisory committee on immunization? Whom does NACI create their recommendations for, and what factors are you considering when making those recommendations?

[Dr. Caroline Quach-Thanh]

Thank you for your question.

Basically, NACI creates the recommendations for provinces and territories so that each province and territory can then take up the recommendations and apply them to its own epidemiology, jurisdiction, logistics concerns, etc. Once our recommendations are out, they are then taken up, mashed up and put into the Canadian immunization guide, which is used by health care providers.

The problem with the pandemic is that everything changes so quickly that the CIG does not have a piece about COVID vaccine. Health care professionals are looking into the statements to try to understand the background to our recommendation. That piece is happening, but it's a little bit delayed, so we've decided that the statements would be used, at the same time, by health care professionals and provinces and territories.

NACI does not speak directly to Canadians, usually. We are there to support the public health measures. Having people go through it and try to understand it might be more complicated. We realize that the language we use is not layman's language. It is what public health understands and what health care providers understand. Even at that level, some health care providers called us to say they were not sure they understood the differences between strong NACI recommendations and discretionary, because this was based for provinces and territories.

The elements we look at to make a recommendation are burden of illness and vaccine characteristics, including safety, immunogenicity, efficacy and effectiveness, but also, as Kim said, ethics, equity, acceptability, feasibility, mathematical modelling and economics, when it comes to that. At this point in time, economics hasn't been incorporated in NACI vaccine decisions, because regardless of how much it costs, we are going to use those vaccines.

When we look at all of those elements, it is possible that a little bit less efficacy will be trumped by the ability to deliver more vaccines to more Canadians, because in our mathematical model, when you compare various possibilities and various scenarios, that seems to be the most optimal.

Are we always right? I can't say that we're 100% right. I mean, things are evolving. You make recommendations based on the best of your knowledge, and we really work at this from a generous and de bonne foi.... There's nothing here that we're trying to conceal; it just happens that this time around, we and Health Canada did not say the same thing.

As I said, it's not the first time it has happened. It's just the first time that people noticed.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you.

Do I have any time, Mr. Chair?

[The Chair, Liberal, Ron McKinnon]

You have 30 seconds.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

To some extent, Kim, the opposition is helping to sow some of this confusion. They continuously talk about how Health Canada ignored the advice of NACI.

Maybe you could tell us how NACI and Health Canada have totally different mandates.

[Kimberly Elmslie]

Of course, I will turn to Dr. Berthiaume in terms of the regulatory mandate, but as we know, Health Canada carries the mandate to regulate vaccines, and therefore looks at clinical trial data, data from the manufacturer, to understand and assess the quality, efficacy and safety of vaccines.

NACI, of course, is using similar data and looking also at real-world data as it becomes available. The mandate of NACI is very much to use the expertise on that committee, which is very multidisciplinary, to provide advice to provinces and territories on the “how” of using authorized vaccines in Canada.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

The provinces choose to take that advice or not. They decide whether they're going to take advice from NACI.

[Kimberly Elmslie]

That's absolutely correct.

[The Chair, Liberal, Ron McKinnon]

Mr. Fisher, you're done.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We'll continue with Mr. Thériault.

You have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, we had an interpretation issue.

Personally, I take comfort in the fact that NACI is not complacent, that it renders opinions based on the science available to it, and that it may not be what we would like to hear. I am perfectly fine with that.

The Public Health Agency of Canada, on the other hand, must ensure that there is buy-in for the message. For the public to buy in, you need their confidence. So we are in a vaccination situation where we have no choice. We are told to take whatever they say we should take.

Ms. Elmslie, don't you feel a little uneasy that 300,000 doses of AstraZeneca's vaccine to come are expired?

Moreover, because of its adverse effects, some countries have decided to stop administering it until more light is shed on the matter. Do you not feel uneasy about that?

Isn't it unusual to receive 300,000 doses of a vaccine that will expire in under a month?