Health Committee on April 16th, 2021

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings round one of questions to a close. We'll now start round two.

My understanding is that the opposition parties have made some arrangements to switch around their time, so we will start round two with the NDP with five minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

My questions are for Minister Anand.

Minister Anand, when you appeared before the committee on February 5, I asked if you would disclose the confidentiality clauses contained in Canada's vaccine contracts. In response, you said:

That's a very good question, and I will take that back to determine whether that would be possible within the confines of the legal parameters of the agreements.

On February 17, I followed up by sending you a letter requesting a timely response to that commitment. I have received no response to date. Given that you've had over two months to consider my request, will you or will you not table the confidentiality clauses of the vaccine contracts to this committee?

[Anita Anand, Liberal, Oakville, ON]

The confidentiality clauses are themselves contained in the contracts. The entire contract is subject to a confidentiality clause. Therefore, I am unable to table the confidentiality clauses alone. However—

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[Anita Anand, Liberal, Oakville, ON]

May I just continue?

I believe that our conversation the last time was about not only confidentiality clauses, but the contracts as a whole.

[Don Davies, NDP, Vancouver Kingsway, BC]

Actually, with respect, Minister, I have limited time, and it was a pretty specific question. Thank you for answering; I appreciate it.

This week, B.C. health minister Adrian Dix said, “The real issue with vaccines is the amount of vaccine we have. If we could get a million more doses, we have the system in place, we have the capacity in place to deliver that...quickly.” He also said, “Despite the unpredictability of deliveries, we are administering the Moderna vaccine as efficiently as supplies allow.”

Saskatchewan premier Scott Moe says that erratic deliveries are challenging his province's vaccination program. The City of Ottawa announced that it's looking to fill a gap in its COVID-19 vaccine supply. The City of Toronto announced that a vaccine shortage is to blame for the fact that local clinics in COVID-19 hot spots in the city have had to close. Also, Dr. Isaac Bogoch, who sits on Ontario's vaccine distribution task force, said, “It's obvious we don't have enough supply.”

Minister, do we have enough vaccine supplies in this country right now?

[Anita Anand, Liberal, Oakville, ON]

In a very competitive global environment in which all countries are seeking access to the precise, same product, Canada has been able to procure vaccines despite the fact that we do not have, at this time, domestic production. In fact, we're the second in the G20 for the rate of vaccinations, in terms of daily doses administered on a seven-day rolling average. We are fourth in the G20 for total doses administered per 100 people.

We have much work to do and we have more doses to bring into this country, but we announced today, in fact, that we're doubling the number of Pfizer doses coming into the country in May and June. We're working, then, as hard as we can to bring more and more doses into the country. This is, indeed, information that we make public to Canadians through the Public Health Agency of Canada as soon as we get it.

We're all in this together. We're going to work with the provinces and territories so that all Canadians have access to a vaccine.

[Don Davies, NDP, Vancouver Kingsway, BC]

Well, the numbers I have, and I just checked them about an hour ago, are that as of April 16, Canada is 41st in the world for doses per 100 people and 63rd in the world for people fully vaccinated.

Are you content with those numbers, Minister Anand?

[Anita Anand, Liberal, Oakville, ON]

We clearly are looking at different numbers, but I'll tell you that my focus every day is getting more and more vaccines into this country. As I said, we stand fourth in the G20 for the total doses administered per 100 people, despite the fact that we don't have domestic production at the current time.

There is more work to be done. We need to bring vaccines into this country as soon as possible, and deputy minister Bill Matthews and I and our team work on this very issue every day. As you can see from this morning's announcement, cumulatively we're going to see between 48 million and 50 million doses coming into the country before the end of June, and that is work we're going to continue to do for Canadians.

[Don Davies, NDP, Vancouver Kingsway, BC]

Minister, the source of that is Our World in Data, which is what is being quoted by pretty much every reputable news organization in the western world. That is where those numbers came from.

Major-General Fortin, at your appearance before this committee on March 12 I asked you whether you were confident that all provinces and territories were prepared to rapidly administer vaccine doses as deliveries arrive in Canada. You said, “Provinces and territories have assured us that they have good plans in place and they have the health workforce required to scale up, so...they have no issues with throughput.”

Right now, there's obviously a problem with vaccines in this country. Is that because the provinces aren't ready, or because there's a lack of supply?

[MGen Dany Fortin]

Mr. Chair, I stand by my previous comment. Provinces have been indicating that they have the resources, that they have the capacity, that they have on-tap capacity to increase the throughput. It's not equal across the board. It's not necessarily a mobile workforce that can get to all places in the country.

They have repeatedly asked for more line of sight on vaccine doses as they become available. We endeavour to share with them as much as possible on quantities as we have that information

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Major General.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

We go now to Dr. Powlowski for five minutes, please.

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

I have to say that I'm a little confused about the order here.

I wanted talk about the risks associated with AstraZeneca and now Johnson & Johnson. I think a lot of Canadians are anxious about these vaccines and whether they're safe, so I want to address that problem.

Specifically, the concern is with blood clotting, but specifically one kind of blood clotting, called VIPID. That is vaccine-induced prothrombotic immune thrombocytopenia, which is associated with cerebral venous sinus thrombosis. It appears mostly in women under 55. The risk of this in the United Kingdom, where they've given a lot of doses of AstraZeneca, has been estimated at between 1 in 100,000 and 100 in 250,000.

I'm a long-time doctor, and medicine is all about balancing risks and benefits. With that in mind, I want to talk a little about risks and benefits and get a response from the doctors on the panel, for example, Dr. Tam and the person from NACI.

My understanding of the British data is that, up until the end of March, they gave over 20 million doses of AstraZeneca, and there were 79 cases of VIPID with 19 deaths. This is probably causal, because this is a very rare combination, but, as a result of giving those vaccines, it's estimated that the British saved around 6,000 lives. There's always a risk in medicine with almost anything.

If you think about an appendectomy, this is a relatively simple operation, and I've done them myself. If it's your kid, you say, “Okay, you have to have your appendix out”. Well, the mortality is 1 in 100, approximately, from my readings. If they take your gall bladder out, the risk is about 1 in 200. We do CAT scans all the time. As a doctor, you have to explain to people the risks and benefits. If your kid is getting a CAT scan, you tell them, “Well, we're not sure of the risk, but it might be something in the order of 1 in 2,000 who will get cancer from a CAT scan”.

With drugs and antibiotics, I've seen people almost die from reactions to antibiotics. As for vaccines themselves, the measles vaccine has a risk of 1 in 700,000 of getting something called SSPE, subacute sclerosing panencephalitis, which is universally fatal. We give the measles vaccine to our kids all the time. My little baby, whom you may have seen occasionally with me on the panel, is going to be getting it in a couple of months. There is always a risk and benefit. No one is forcing people to have AstraZeneca or Johnson & Johnson. I have to say, the risk with Johnson & Johnson seems to be 1 in a million.

Before the practitioner, nurse or doctor gives you the vaccine, AstraZeneca, they're going to explain the risks and benefits. I would submit there's a very, very small risk from the vaccine. In fact, I calculated that you're seven times as likely to die in a car accident the year after you've been vaccinated with AstraZeneca as you are to die from a blood clot, so the risk is very low. The benefits in terms of protecting yourself from the virus are significant.

I want to ask Dr. Tam or the representative from NACI about the risks and benefits. Obviously, I've outlined my view of it.

Thank you.

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Mr. Chair, thank you for asking me to be here today. I'll take the question first.

I would say that Canadians should be very comforted in knowing that we have a very rigorous system in Canada for ensuring that the vaccines that they will get in their arms are safe as well as effective. Health Canada, as the regulator, does very rigorous assessments of vaccine safety, and they've been linking with European and other international regulators to get the information we need.

We acted fast when we saw that there was a signal from Europe. With that, the National Advisory Committee on Immunization also took an initial assessment and a precautionary approach in putting a pause on the use of the AstraZeneca vaccine in persons under the age of 55.

Right now, Health Canada, having asked the company, AstraZeneca, for more information, has done its assessment and analysis and concluded that the benefit outweighs any risk of this rare but serious adverse event overall. The National Advisory Committee on Immunization is doing its due diligence in analyzing this information right now. What the committee has to do is not just analyze the risk of this rare side effect but also the balance in terms of the benefits of prevention of COVID-19 in different age groups. The committee is doing this work very diligently right now and will come out with a new reassessment soon, as Dr. Tunis indicated.

Again, Canadians should be very heartened by the fact that our vaccine safety system and how we assess vaccine safety is extremely rigorous.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski and Dr. Tam.

We need to go now to our next question slot, which is, I understand, Mr. Thériault.

Mr. Thériault, we now go to you. You have five minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

In order to maintain the public's confidence and support when it comes to the Public Health Agency's guidelines and messages, the agency has to act in a consistent manner and, as Dr. Tam said, apply the precautionary principle.

The last time we met, three countries had decided to suspend use of the AstraZeneca vaccine. Back then, the agency and Health Canada were saying that it was just three countries, that the cases were not that serious, and that Canada would keep using the vaccine.

I've lost count of all the attempts made to save the AstraZeneca vaccine and keep the same messaging out there. Nevertheless, had we suspended use of the vaccine and waited for the European Medicines Agency to come out with its decision, it would have saved a lot of wasted breath and defensive communications. Not to mention, it would have fostered greater public confidence.

It would have been clear that the authorities were being proactive and applying the precautionary principle. We were not proactive and we did not apply the precautionary principle, undermining the very principle we wanted to uphold. Instead, we went against it. Public fears about receiving the vaccine have emerged. Conversely, when the vaccine was offered to people 55 and older in Quebec, without an appointment, we did see an appetite for it. However, it was thanks to the fact that they did not need an appointment.

Since then, the appetite for the vaccine has dropped significantly. Vaccination clinics are nowhere near full, even when people don't have to have an appointment. It pays to take a cautious approach so as not to produce the opposite effect. A mistake was made, and recognizing that is important.

Dr. Tam, can you explain how the variants work to help us understand what's going on right now? How are we seeing so much variant spread when we are taking so many precautions and when the government claims to be strictly enforcing measures and controls? Do you have any data that would tell us more about the main hot spots?

[Dr. Theresa Tam]

Canada actually has been at quite a high level compared to other countries in terms of doing our genomic sequencing and surveillance for variants. We are sequencing a lot more virus than any other country, and we have been able to detect the variants across Canada. All provinces and territories are able to detect for themselves or access support from the National Microbiology Laboratory to do this. We have actually quite good visibility as to where the variants are in this country.

Why we are concerned and why we call them “variants of concern” is because they spread more readily. You have to be much more careful with your measures. We know that public health measures work, and we've seen it in the United Kingdom, Ireland and other countries that have had these variants of concern. We know what to do across Canada. The important thing is that, from the local level up, things have to be applied rapidly—as quickly as possible—to control the spread. The method is not different; we just have to be more stringent.

[Luc Thériault, Bloc, Montcalm, QC]

Sorry to cut you off, Dr. Tam, but with the borders closed, entry control measures and testing in place, and all the rest, could you please explain why the variants detected in Canada are so virulent?

Do you have any data that helps you to understand what is happening in the main hot spots? What are the causes?

[Dr. Theresa Tam]

There are different variants in different areas of the country, but the B.1.1.7 variant is present in all provinces. I think there's only one jurisdiction that doesn't have that variant. We have a good understanding that the B.1.1.7 variant is becoming the predominant one, and it is more easily transmitted.

Again, more application of the same tried-and-true public health measures can get those rates down. You're seeing Quebec, Ontario and other places applying some of these measures right now, and that has to be done very quickly. We understand—and we have data from jurisdictions such as Ontario—that some of these variants seem to be causing more severe outcomes. You're seeing that in hospitalizations and ICU visits. The data is there to track and look at the impacts.

To me, the really important thing that you need to do is have what I would call “a final go” at suppressing the epidemic, so that the vaccines can have time to work.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

I gather, then, that you have not ascertained the main causes of the virulence and spread of the virus in the main hot spots.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Ms. Sidhu.

Ms. Sidhu, please go ahead for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you to all the witnesses for being here with us today.

Minister, you and your officials have been working non-stop for well over a year to protect the health and safety of all Canadians.

My first question is to Minister Anand. Can you tell the committee about the update we just received from Pfizer? How will this impact the government's vaccine procurement and distribution plans to provinces and territories?

[Anita Anand, Liberal, Oakville, ON]

I'd be pleased to share the good news from Pfizer today. We have negotiated the exercise of an additional eight million options with Pfizer, so that means that not only are we purchasing these options, but they're going to be delivered in the very short term.

We expect to have two million doses of Pfizer delivered in May, and 12 million over five weeks in June. In addition to the other vaccines in our portfolio, this means we are going to, cumulatively, have between 48 million and 50 million vaccines in this country prior to the end of June.

I want to reiterate that when we put our contracts into place last summer—and indeed our portfolio is a diversified one, with multiple contracts and multiple suppliers—we wanted to make sure we had access to multiple sources of vaccine supply. We are pulling vaccine now not only from Pfizer but also from Moderna, AstraZeneca and J&J. That is very important.

I would like to clarify a point about our rankings. I was speaking about the G20, whereas my honourable colleague was speaking about all countries in the world. We are indeed second in the G20 for the rate of vaccinations, and fourth in the G20 for the total doses administered per 100 people. Why? It's because of our diversified portfolio, and because we're pulling in vaccine from multiple sources.

We will continue to do that, and distribute those vaccines to the provinces and territories as soon as we receive them. Indeed, Pfizer's go directly to the provinces and territories as it currently stands. We want to make sure we are with Canadians and supporting Canadians right through to the end of this pandemic with our vaccines.