Health Committee on March 11th, 2021

[Dr. Marc Berthiaume]

That standard has been adopted internationally.

[John Barlow, Conservative, Foothills, AB]

If we have the same standard of 50% in Canada, why are we approving the use of the AstraZeneca vaccine, which has not met that minimum standard here?

[Dr. Marc Berthiaume]

The AstraZeneca vaccine has demonstrated 100% efficacy in clinical trials to prevent cases of hospitalization, so there has been evidence of efficacy. On the symptomatic cases, the data was not sufficient, because the number of cases was too small because the number of patients in clinical studies was too low.

[John Barlow, Conservative, Foothills, AB]

To that question, Dr. Berthiaume, it sounds like you're being creative with the numbers. The stats that we have are that AstraZeneca is 43% effective, so the answer is either that we're approving the use of AstraZeneca, which has 43% efficacy, or that we don't have enough data. To me, it sounds like you're approving the use of a vaccine that is below the standard that is set internationally. It's either 43% or non-existent.

[Dr. Marc Berthiaume]

If I can comment on that, please, the standard of 50% is for the overall efficacy of the vaccine. It's not subject to subpopulation analysis. The overall efficacy of the AstraZeneca vaccine is 62%, and when the doses are spaced, there's some evidence to suggest it could go up to almost 78%.

[John Barlow, Conservative, Foothills, AB]

You're touching on the problem, I think, that all of us on this committee are having—and I would argue the vast majority of Canadians—where every single time, on this health committee, when we're asking questions of those we would expect to be experts, we are getting different answers, different numbers, different statistics.

I don't want to say you're manipulating numbers, but you're finding a way to ensure that AstraZeneca fits a very narrow window where the vast majority of Canadians.... There is confusion here. When we're hearing what's happening in Europe and Scandinavia, on this panel you're giving very different answers to each one of us on this committee, whether it's me or Mr. Davies or Mr. Thériault—

[Dr. Marc Berthiaume]

Health Canada's information—

[John Barlow, Conservative, Foothills, AB]

I haven't asked you a question.

[Dr. Marc Berthiaume]

I'm sorry.

[John Barlow, Conservative, Foothills, AB]

It's okay.

To either Dr. Berthiaume or Dr. Quach, has the Minister of Health raised the concern of the confusion and the impact that will have on vaccine hesitancy or concerns amongst Canadians? Has the minister raised with Health Canada or PHAC the concern that this confusion is causing?

[Dr. Caroline Quach-Thanh]

I can tell you that the Minister of Health hasn't raised anything with us. We realize, not being stupid, that having conflicting recommendations is going to be a problem. That's why we're aiming to have technical briefings or whatever to explain why there is divergence.

The problem is that we are an independent committee. As much as we would all like to say the same thing, aiming for uniformity would mean that if we were not in agreement, we would have to comply. I'm not sure that aiming for harmony is necessarily what we should be doing.

[John Barlow, Conservative, Foothills, AB]

I would argue, Dr. Quach-Thanh, the opposite. Canadians are looking for direction. When we have two organizations we should trust giving us two different answers, you can understand the concern and the worry this is causing among Canadians.

I have time for one last question.

The AstraZeneca vaccine that we've been given has an expiration date of early April. Is there any data that shows that the closer this vaccine gets to its expiration date, the efficacy or effectiveness of that vaccine deteriorates? Is there any data that shows that it is just as effective on the day of its expiration date as it is the week before that expiration date?

[Dr. Marc Berthiaume]

The answer is that pharmaceutical products or vaccines are as good on the first date as they are on the last date before the expiry. So, yes, from a quality perspective, it's as good as if it was further from the expiry date.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Barlow.

We go now to Mr. Van Bynen.

Please go ahead for five minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

I'd like to take a moment to acknowledge the one-year anniversary since COVID-19 was declared a pandemic, and the lives across Canada that have changed, some of them forever. Today, my respect goes out to all who have lost loved ones and friends, and to our health care heroes who have been on the front line of this fight since the very beginning, as well as to our scientific community, including the ones who are here with us today. I want to thank you all for joining us.

I'll begin with a question for Dr. Njoo. I believe some Canadians may not be aware of the reason why COVID-19 vaccines use a two-dose schedule to reach the very high levels of immunity. Can you walk us through how each of us will gain immunity to COVID-19 through vaccination? Let's start with getting the first dose and going through to the second.

[Dr. Howard Njoo, Deputy Chief Public Health Officer, Public Health Agency of Canada]

Thank you very much for the question. I would also defer to Dr. Quach-Thanh for further comments, because NACI, Dr. Quach-Thanh and the other members went through the evidence to look at exactly what the real-world data shows, in comparison to the clinical trial data that was obviously used by Health Canada in terms of the approval of the vaccine.

Based on the very good evidence that was presented...for example even Canadian evidence of what happened in British Columbia and Quebec in terms of the high level of protection even after one dose to the residents in long-term care facilities. Based on the principles of vaccinology and immunology, we know that immunity normally doesn't just drop right off after a few months. Certainly, there's been no evidence from other experiences in other countries that this has been the case.

That's why.... And I certainly would defer to Dr. Quach-Thanh. They came out with the recommendation that the interval could be extended up to four months. As Dr. Quach-Thanh said, that doesn't mean that every Canadian who gets the first dose will have to wait exactly four months. It all depends on the shifting of supply, because obviously we're anticipating getting many more millions of doses into the second quarter and beyond.

Overall, from a population health perspective, the thinking is.... Certainly the chief medical officers of health in the provinces and territories, having heard the presentation by NACI a week or so ago, are of a general consensus that it makes sense to immunize more Canadians rapidly with that first dose, given the high level of protection, to have that overall level of population protection. Certainly, as the doses come in, in greater quantity, they would be able to give that second dose.

That is the overall end result in terms of how the provinces and territories are taking the NACI advice. Obviously, within their own context, they are operationalizing it to the maximum benefit of their populations.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

I'd like to share my time with Dr. Powlowski, but I want to clarify one point. Dr. Njoo, the doses are administered after the advice of professional medical doctors, and not administered by rote. Is that correct?

[Dr. Howard Njoo]

At the end of the day, yes, giving a vaccination is a clinical medical decision. It is a medical act between a health professional and the patient. I think in the normal, ideal setting there's always informed consent. The patient is obviously informed about the risks and benefits. That's an individual interaction between a physician or a health care provider and a patient.

I think what you're also referring to is that, at a population level, from a programmatic perspective, certainly as the vaccine programs are rolled out in each of the provinces and territories, the overall stance in operationalization has taken that population perspective into account.

Thank you.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

I'll turn it over to Dr. Powlowski.

[The Chair, Liberal, Ron McKinnon]

Dr. Powlowski, you have 45 seconds.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I'd like to ask a question about the association between the AstraZeneca vaccine and DVTs or PEs. Just because some of the very many people who got the vaccine developed PE or DVT, that obviously doesn't mean a lot. In a place like Thunder Bay, with a population of 100,000, the regional hospital may see five to 10 DVTs or PEs any given day.

How many people actually got DVT or PE, and how does that compare with the overall incidence of those things in the general population? From what I hear, it doesn't sound all that impressive an association.

[Dr. Marc Berthiaume]

I'm sorry; is that a question?

[The Chair, Liberal, Ron McKinnon]

Give a quick answer, please.

[Dr. Marc Berthiaume]

The point I was trying to make before is that those events occur naturally in the population. To make a link between the vaccine and the event, you have to determine if the rate of events is higher than the natural occurrence in the population, which has not been made at this point in time.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Thank you, Dr. Powlowski.

We'll now go to Mr. Maguire.

Please go ahead for five minutes.