Health Committee on March 12th, 2021

[Dr. Theresa Tam]

The central foundation of the NACI advice is the high effectiveness and safety of that first vaccine dose. That is absolutely what they base the recommendations on.

Not only that—

[John Barlow, Conservative, Foothills, AB]

Thank you, Dr. Tam. I appreciate that.

I'll just move on to my next question.

Minister, does the off-label use of the Pfizer vaccine contravene any section of the agreement we have with Pfizer for the use of their vaccines?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I'll turn to Deputy Lucas to talk about the regulatory approval for Pfizer.

[Dr. Stephen Lucas, Deputy Minister, Department of Health]

Health Canada makes its regulatory decisions against the standards for safety, quality and efficacy based on the clinical trial data provided by the manufacturer—in this case, Pfizer. In terms of the practice of medicine and how it's used, in Canada we have the National Advisory Committee on Immunization, which provides advice on the use of vaccines, as they've done to date for Pfizer, Moderna and AstraZeneca. In that context, they take into account the clinical data and other factors from a public health perspective and real-world evidence, if it's available, that allow them to provide that advice for the use of the vaccine in a real-world setting.

[John Barlow, Conservative, Foothills, AB]

Mr. Lucas, I just asked if it contravenes any aspect of the contract we have with Pfizer. It's a very simple question. It's yes or no.

I'll move on to my next question.

Has any consultation been done with the insurance companies in Canada when it comes to our health insurance? Does extending and going off-label from the recommendation on the vaccines impact eligibility for health insurance? We have certainly heard from constituents who have had conversations with their health insurance provider to the effect that if they are vaccinated using the vaccine off-label, off the recommendation, it will invalidate their health insurance should they pass away or have a health issue as a result of COVID.

When you made the recommendation to go off-label, did you have those consultations with Canada's health insurance providers?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

The NACI recommendations are not made by the government. They're made by an independent advisory body. Provinces and territories can then choose to use that NACI guidance to direct their actions in terms of their vaccination priorities and practices.

[John Barlow, Conservative, Foothills, AB]

Thanks, Minister.

There is some responsibility for you, as the minister and as the government, to oversee decisions that will have a massive impact on the Canadian public. If NASI makes this decision, I would suspect that you, as the government, would also take the prerogative to have those discussions with health insurance providers, for example. Clearly, you did not see that as an issue.

I'll move on to my last question.

We know that the WHO and the FDA have minimum standards when it comes to efficacy guidelines. Does Health Canada have a minimum efficacy standard?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Yes, there are a variety of very rigorous standards, I would say, that any drug or medical therapeutic needs to go through before it's approved by Health Canada.

Dr. Lucas, can you please take this question?

[Dr. Stephen Lucas]

In November 2020, Health Canada did publish our standards in terms of the safety, quality and efficacy expected for vaccines. The efficacy standard is at least 50% efficacious—

[John Barlow, Conservative, Foothills, AB]

Thanks. That's the answer I wanted. Why did the government approve AstraZeneca for use with Canadian adults over 65 when its efficacy is below the standard of 50% that you set? It's 43%. Why would you approve a vaccine for use on Canadians when it is below the standard?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I'll turn to Dr. Lucas for that. There are some misrepresentations in the question.

[Dr. Stephen Lucas]

Mr. Chair, in considering the regulatory decision in regard to the AstraZeneca vaccine, the regulator examined the evidence provided through the clinical trials, as I noted. Additional evidence was provided through real-world experience, including through structured studies. On that basis, the regulator determined that the benefits outweighed the risks and authorized the vaccine for use in people 18 years of age and older.

[John Barlow, Conservative, Foothills, AB]

The minister can't say what I said was wrong. The data says it's 43%—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Barlow.

We go now to Mr. Kelloway. Mr. Kelloway, please go ahead for five minutes.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thanks, Mr. Chair. It's great to be back to ask a few questions.

My first question is for the minister.

Minister, you and your colleagues have a great team, so if you want to ask others to join in, please do so.

My question is around variants of concern. We know that these variants have taken hold in Canada and are spreading in different parts of our country. I guess my question is twofold. How are we tracking these variants and how is their presence changing our government's response to COVID-19?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much to the member.

He's absolutely right. We are taking a multi-layered approach to keeping Canadians safe. Obviously, everything we do has to be in partnership with provinces and territories, as they deliver health care in their own jurisdictions and have the right and the responsibility to do that.

As part of our work to support tracking variants, we've invested $53 million to create a variants of concern strategy, which will increase monitoring and surveillance of new COVID-19 variants in Canada. I think you heard Dr. Tam say that this work has accelerated extremely quickly, and we're testing positive cases across the country to get a better handle on where these variants of concern might be, obviously in partnering with experts in research and public health. This is a very important piece of work, especially right now as we stand at such a critical point in our battle against COVID-19, including vaccinating Canadians.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Would anybody else like to join in?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Maybe I can turn to Dr. Tam, because what has happened in the last couple of months in terms of our ability to track these variants is quite incredible.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Minister.

[Dr. Theresa Tam]

Yes, even prior to the acceleration of the capacity, we were doing quite well compared to other countries. Now we're whole-genome sequencing over 10% of our cases. In provinces, the vast majority are screening 100% of the possible cases for mutations. That's a great milestone. That's just to say that variants of concern are increasingly identified in Canada. We now have 3,000 cases of them in Ontario and other places as well.

You've seen some of the latest data coming out of Ontario. About 40% of the cases of variants of concern are mainly of the B.1.1.7 variant, with increased transmissibility, as they have shown in their modelling and their data, and there are certainly concerns about an increase in severity. Of course, how we manage these variants does have to be adjusted according to that data, and provinces are easing their measures very carefully. I'm seeing commitments for them to clamp down on the variants as they detect them, but I think we're in a better spot in terms of detection.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you so much, Dr. Tam.

I'm going to go back to the minister.

Minister, I'm a huge advocate for seniors in my riding, and I know that my colleagues are huge advocates for seniors in their ridings. My favourite senior is my mom, and as you know, she is a huge fan of yours.

Seniors like my mom have felt the impacts of this pandemic, as we all have, but our government has stepped up to the plate to help seniors. I'm wondering if you could tell us and those who are watching more about how we've supported seniors through these challenging times. Can you give us and those who are watching a sense of what we have done?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much, and please say hi to your mom for me. I have never met her, but she sounds like a wonderful woman and I've enjoyed your stories of her.

I'll say that we knew right away that seniors were going to struggle, especially since seniors in particular often face isolation already. When we were asking people to stay home and avoid going out, we knew that for those seniors not living in long-term care isolation would be difficult, but for those in long-term care it would obviously be even more so.

We worked very closely as a whole of government to increase access to financial supports for seniors and to ensure that New Horizons programs across the country had additional money to rapidly change how they were connecting to seniors in communities. Obviously, all the work we did to support provinces and territories in long-term care work was very critical. We'll continue to do that work for seniors.

The seniors across this country have been there for us in our toughest times, so it's time for us to be there for them, and that's why I'm so honoured to be Canada's health minister and to be working on the many ways that our government can support seniors to have healthier, more dignified lives.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Minister.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Minister, let me make you aware of the reality that the provinces and Quebec may be experiencing. I know that health care does not fall under federal jurisdiction. Perhaps that is why you are a little removed from the reality created by the first two waves of the pandemic.

The Quebec ministry of health and social services report I was referring to indicates that, in the first wave, 4,119 people with cancer were not diagnosed in Quebec. In addition, from April to June 2020, there were 1,539 fewer cancer surgeries. For the same period, the number of radiation treatments decreased by 9%. There were 58% fewer of the most common prostate cancer screening tests. Medical imaging tests to detect lung cancer, the leading cause of death for both women and men, were down by 21% last spring.

That's the reality for non-COVID-19 patients.

The report also shows that the number of lung cancer surgeries for the period April through June 2020 decreased by 18% compared to the same period in 2019. The largest decrease was in April with 42%.

The same was observed with colorectal cancer, which is also very common. We have seen an incredible drop in the number of screening tests and the number of surgeries has dropped by 30%. I could go on and talk about breast cancer as well.

As a result, Mario Décelles, the director general of the Fondation québécoise du cancer, said that the numbers may unfortunately be worse in the second wave. This report was published at the end of January 2021, and the numbers in the second wave will be even worse.

You have the nerve to tell us today that we need to separate the approaches and deal with the pandemic first, as if the reality I am talking about is not urgent. Health transfers can solve this problem.

What are you going to do when non-COVID-19 patients die because they are not diagnosed, Madam Minister?

Are you going to say that this was not your responsibility and that the pandemic needed to be addressed first?