Evidence of meeting #24 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was naci.
A recording is available from Parliament.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Okay.
Ms. Elmslie, I will note that I might have to put forward motions to compel information from your committee that you said you would provide but have not been provided yet. I find that unacceptable.
Dr. Berthiaume, have you had any interaction with Pfizer or Health Canada with regard to the decision on the dosing interval going from three weeks to four months? Have they advised you in any way on that?
Director, Bureau of Medical Sciences, Therapeutic Products Directorate, Health Products and Food Branch, Department of Health
I'm sorry. I'm not sure I understand the question. The discussions between Health Canada and Pfizer were for the approval, and they continue about ongoing data and safety issues, but the way the doses are administered in the provinces is not a matter that is written—
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you. I'm on my last question with the time I have left.
Dr. Quach-Thanh, did NACI consider the possibility of the development of vaccine-resistant variants, as a paper in The Lancet recently discussed, in your decision to recommend increasing the dosing interval of the Pfizer vaccine to four months?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
We did, and the immunologists we consulted said that this was a theoretical risk and that they didn't see why extending the interval would increase the risk of having variants show up. The most important thing—
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Can you table that data with this committee in the next week?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
It was a discussion, but I can try to get you something in writing.
Conservative
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Rempel Garner.
We'll go now to Mr. Kelloway.
Please go ahead for five minutes.
Liberal
Mike Kelloway Liberal Cape Breton—Canso, NS
Thank you, Mr. Chair.
Before I get into my questions, I just want to thank all the witnesses as well for the work they're doing on behalf of Canadians, and I want to thank them for answering all the questions tonight. In my opinion, it's easy to criticize distribution plans, recommendations and decisions, and in some cases to incite fear in people when it comes to the vaccines. However, I have full confidence in you folks, and I know that you have the best interest of all Canadians in mind. I'm really filled with gratitude for the work you're doing. In my opinion, you're not just Canadian leaders; I truly believe you're world leaders.
I'm going to start off with Dr. Quach-Thanh. I guess it's a practical scenario, and it's kind of how we roll here in Cape Breton—Canso. Here in Nova Scotia we've begun vaccinating seniors over the age of 80. My mom actually received her letter last week. We are all very pleased by that.
I noticed when booking a vaccine appointment that there is now up to a 105-day waiting period between the administration of the first dose and the second dose, rather than two to three weeks between the doses.
I think you've highlighted this, but this is a chance for you to do a deeper dive. I'm wondering if you can explain to the committee—and, just as important, to those following at home—why NACI is recommending that COVID-19 vaccine intervals between the first and second dose could be extended up to 105 days. Also, can you give us a deeper synopsis of what has changed since the original recommendations?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
I'll start with the last part of your question.
What changed since the original recommendation was that data came out of the U.K., Quebec and B.C. showing that at eight weeks we still had higher than 80% effectiveness, even in the long-term care residences, which to us was a sign that these vaccines are actually quite good.
As I said, given the mathematical modelling, what we did was decrease the vaccine effectiveness over time which...a more or less steeper curve to that decline. Regardless of the decline, giving one dose of vaccine to as many Canadians as possible was the scenario that most decreased the number of hospitalizations and deaths, mainly when you give it now because what's important is now. Maybe Nova Scotia is great, as you don't have that much transmission, but in other provinces it's rampant.
What we want is to decrease transmission as quickly as possible, because then you decrease the risk of having variants come up. A variant happens when the virus replicates and makes a mistake, and that mistake is actually good for it. If it replicates less, because it's transmitting less, then you decrease the risk of those variants occurring. Based on the data, we decided to extend the interval to allow for that first dose to be given to as many people as possible.
I think what is very important in all this is that we have surveillance systems for effectiveness so that we have real-time data of what's happening. In Quebec, B.C. and Alberta, and probably in Nova Scotia as well, people are able to say, “We're now at nine weeks and the vaccine effectiveness is X. We're still good to go. We're now at 10 weeks and the vaccine effectiveness is Y. We're still good to go.” When we see that it decreases anywhere, it's then easy to say, “We're rolling back the vaccines and starting to give that second dose now.”
All it means is that the vaccines are there, instead of decreasing in the people under 60, people with underlying medical conditions between 18 and 59. You bring back those vaccines and you say, “Those who were first vaccinated aged 70 and over, we're now giving it to them.”
We have the ability to follow a vaccine's effectiveness in time, and it is because of this that we're able to say.... We don't have all the data. I would be lying to you if I said we did, but we have the ability to change our recommendations quickly, and the provinces are doing that very well.
Liberal
Liberal
Mike Kelloway Liberal Cape Breton—Canso, NS
I'll try to get this in.
I'm sure many of you here today are familiar with the famous French scientist and vaccine pioneer Louis Pasteur. He once said, “Do not let yourself be tainted with a barren skepticism.” I think that quote is relevant today.
Dr. Njoo, are you concerned that questioning the safety of the delay of the second dose, despite clear science and the evidence that's available, feeds into the vaccine hesitancy? Basically, how can we reassure Canadians that all vaccines approved for use in Canada are safe and effective?
Deputy Chief Public Health Officer, Public Health Agency of Canada
Thank you very much for the question about vaccine hesitancy. Obviously, it's a complex issue and there are many facets to it in terms of improving vaccine confidence in Canadians overall. There are multiple facets.
First of all, we have one of the most respected and most rigorous regulatory systems in the world with our colleagues at Health Canada. I think Canadians have assurance that any vaccine approved in Canada is both safe and effective. I think that's the first step.
Certainly, mass campaigns and the press conferences that many people, including me and Dr. Tam, are involved with are also important, in terms of reinforcing key messages to Canadians about the importance of vaccination and how it benefits them in terms of protection.
We also recognize—and I think this is a key point that maybe hasn't been raised—that Canadians, in terms of getting information to improve their comfort level with vaccines.... It's not because of me personally; I think it's because they have trust in their personal health care provider. One of the important things that we're also doing, through webinars and so on, is giving the tools so that frontline health care professionals and providers feel empowered and are able to give credible information so their patients can make an informed decision regarding getting vaccinated. I think that's a key step.
Another part is that we recognize there might be different levels of reticence or vaccine hesitancy in certain racialized communities. Therefore, it's also very important to engage with community leaders in those communities. We've seen them do that, for example, in various indigenous communities. The leaders have come forward, gotten vaccinated, put it on social media and said, “Look at this. I got my vaccine. I'm protected. My family is protected. It's good for me. It's good for everyone.” Those are the kinds of things we're doing.
I would also say that, at the end of the day, there is a bit of a responsibility on every Canadian. The fact is that the Internet is a powerful tool and there's a lot of misinformation, disinformation and so on. The responsible use of the Internet, in terms of not using clickbait and making misinformation go viral, is also very important.
Finally, I want to say that—
Deputy Chief Public Health Officer, Public Health Agency of Canada
That's fine. Thank you very much.
Liberal
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you, Chair.
Dr. Quach-Thanh, why was four months selected as the dosing interval for Pfizer? Why not three or five? Why four?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
That's an excellent question.
The modelling has shown us that the ideal interval would be six months if we wanted to have the most gain in terms of decrease in hospitalizations for Canadians. However, when we looked at six months and the supplies that we were going to have, we were told that we would never need to go beyond four months because we would have enough doses to do that.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
So four months was chosen simply based on a vaccine delivery schedule?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
It was based on vaccine delivery and mathematical modelling.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Okay, so there was no actual scientific.... This was based purely on a procurement schedule, like desperation in a procurement schedule.
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
There is a basis of science, but you're right that four months—and not four and a half or five—was based on procurements.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Wow. I'm kind of shocked.
Do you think Canadians might be concerned that you're making decisions based on procurement schedules rather than on solid clinical data?
Chair, National Advisory Committee on Immunization and Professor, Université de Montréal
The thing is that we looked at a six-month interval but didn't think we would need to go up to six months. You can look at the literature. Very renowned vaccinologists, such as Stanley Plotkin in the U.S., are also recommending delaying the second dose for as long as needed to give that first dose to as many people as possible.