Health Committee on March 11th, 2021

[The Chair, Liberal, Ron McKinnon]

Steady down, everybody.

Doctor, you'll have a time slot in the third round.

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

Is there no such thing as a point of clarification on the witness testimony?

[The Chair, Liberal, Ron McKinnon]

It interrupts the—

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

I think it's totally central to what we're talking about.

[John Barlow, Conservative, Foothills, AB]

Mr. Chair, he has a speaking slot. That's it.

[The Chair, Liberal, Ron McKinnon]

Doctor, we can't allow it at this time. If one of your colleagues would like to share their time with you, that would be okay, but at this point, the speaking time for all the parties is well defined.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Chair, I will share my time with Dr. Powlowski.

[The Chair, Liberal, Ron McKinnon]

All right, Ms. Sidhu, you have 40 seconds left.

Dr. Powlowski, you have 40 seconds.

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

Thank you, Ms. Sidhu, for that.

I think this is really important and probably most of the members in the committee didn't pick this up. A large part of the public might not appreciate the difference.

Dr. Quach-Thanh, you talked about the efficacy versus the efficiency, and the numbers are very different. Can you once again clarify that so we understand the difference between those two terms? What is the efficacy versus the efficiency?

[Dr. Caroline Quach-Thanh]

Absolutely. Thank you for that question.

Efficacy means the vaccine impact in a randomized control trial where you actually choose the population—choosing in the sense that you have very strict inclusion and exclusion criteria. Usually your population is healthier than when you use it in the real world.

Effectiveness is the impact of a vaccine when it's rolled out at the population level, which means that everybody is vaccinated. You have immunosuppressed patients, people with underlying medical conditions and malnourished people who might not respond as well to a vaccine. You always expect the rate of effectiveness to be a little bit lower than the efficacy because you have a much more varied population in whom the vaccine might not work as well as when you select—not cherry-pick, but very strictly select—the participants in a study.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We'll now turn to Mr. Thériault.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Berthiaume, why wasn't the AstraZeneca vaccine approved with a warning for people aged 65 and over?

[Dr. Marc Berthiaume]

The AstraZeneca vaccine was approved because Health Canada considered that it had enough information to recommend its use for people aged 65 and over. I can say that—

[Luc Thériault, Bloc, Montcalm, QC]

Sorry to interrupt you, Dr. Berthiaume. You said that there was enough information. What does that mean?

[Dr. Marc Berthiaume]

It means that there's enough evidence. Health Canada makes a decision based on the evidence submitted.

[Luc Thériault, Bloc, Montcalm, QC]

Okay. Obviously, the National Advisory Committee on Immunization, or NACI, is telling us that the vaccine is 43% effective. Isn't that right?

Who should take the advisory committee into account? The Public Health Agency of Canada must deal with a pandemic. It has two bodies. The goal is to get vaccines, but when it comes to the AstraZeneca vaccine, there's some passing the buck.

Some people in Quebec say that the vaccine was approved. However, it was approved without any warning about its effectiveness for people aged 65 and over. When we're told about the relevance of the vaccine, we hear that this falls under a vaccination strategy based on the scarcity of the resource.

If the resource isn't in short supply, is the approval granted anyway? Is this done without any warning? In other words, why was this vaccine approved?

[Dr. Marc Berthiaume]

As I tried to explain earlier, there are several pieces of data to consider when looking at the effectiveness of the AstraZeneca vaccine. For example, in groups of 600 to 700 patients aged 65 and over that included a placebo group and a vaccine group, there were no hospitalizations among the vaccinated individuals and eight hospitalizations among the non-vaccinated individuals.

When we look at the efficacy of a vaccine, we take into account different factors, such as the prevention of asymptomatic infection and the prevention of symptomatic infection. Most of the efficacy data discussed so far today concerned efficacy against symptomatic infection.

Then there's the efficacy against hospitalization and death. This is a significant aspect of vaccine efficacy. In the case of the AstraZeneca vaccine, not only the clinical trial data, but also the real-world efficacy data have shown that the vaccine prevents and significantly decreases severe and serious cases, such as the cases that clog hospitals and cause deaths.

[Luc Thériault, Bloc, Montcalm, QC]

You're saying that, even though the vaccine is 43% effective in people aged 65 and over, it prevents serious forms of the illness.

Is the decision to offer this vaccine optimal for all people? In a way, doesn't the decision to offer it without a warning create uncertainty for people who are feeling uncertain right now?

We learned today that there was an issue. Who will make a decision? Certainly not the National Advisory Committee on Immunization, or NACI, because the committee is advisory.

Will it be the Public Health Agency of Canada, Health Canada?

Who will make the decision to suspend the use of this vaccine, as was done in Norway, Denmark and Iceland?

Why didn't you apply the precautionary principle?

[Dr. Marc Berthiaume]

The 43% effectiveness that I referred to wasn't statistically significant, because there were too few cases.

I could add that the agency—

[Luc Thériault, Bloc, Montcalm, QC]

Wait. Are you telling me that the NACI is currently saying that the use of a vaccine that's 43% effective isn't recommended and that you're ignoring this because the data isn't significant?

[Dr. Marc Berthiaume]

As Dr. Quach-Thanh explained, I'm saying that the 43% has a very wide confidence interval that even extends into the negative.

Even though the rate obtained is 43%, this isn't a statistically reliable value given the small number of cases in the study.

[Luc Thériault, Bloc, Montcalm, QC]

The new studies likely to undergo a review in the next few days will give us a little more insight. However, you didn't answer my question.

Who, according to the precautionary principle, will suspend vaccination until the adverse effects of the vaccine are clarified?

[Dr. Marc Berthiaume]

You're referring to a—

[Luc Thériault, Bloc, Montcalm, QC]

Do you make the decision?

[Dr. Marc Berthiaume]

Mr. Thériault, I would like to answer your question.

You were referring to thromboembolic events in Europe. The vaccination of certain groups has been suspended in some countries. However, the administration of the AstraZeneca vaccine hasn't been completely suspended in Europe. The vaccine is currently under investigation.

The point is that, when you give a vaccine to millions of people, sometimes there will be—