Health Committee on April 16th, 2021

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

Thank you very much, Dr. Tam.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We go now to Mr. Dreeshen.

Mr. Dreeshen, please go ahead for five minutes.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Thank you very much, Mr. Chair. It's great for me to be back here to discuss something that's extremely important to all Canadians.

A little earlier, Dr. Tam said that they look at the science and the data, and no matter what the manufacturer says, they make decisions based on that.

Are we the only ones in the world who are capable of coming up with a detailed analysis of such a circumstance?

[Dr. Theresa Tam]

I would say that many countries in the world follow the same process.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Does that mean there are a number of countries in the world, then, that are delaying the 21 days or 28 days, to push it out to four months? Is that what is happening throughout the world?

[Dr. Theresa Tam]

I misunderstood your question. I'll just clarify.

The United Kingdom, for example, right at the outset, looked at a 12-week interval for all the vaccines, and our National Advisory Committee on Immunization has been following not just that data but also domestic data from B.C. and Quebec. We are a leader in the world, particularly in terms of the studies in those two provinces, at looking at that stretch interval, and so far the vaccine effectiveness has been very high, even at that 12-week mark. We're monitoring that very carefully.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Thank you. That's great to know, because I'm sure the rest of the world will be waiting for us, for the studies we've done.

What about the concept of mixing vaccines? There are a lot of people who are thinking there's going to be a four-month delay before their next one. They might have taken a Pfizer vaccine, but perhaps a Moderna one might show up earlier, or quite frankly, the way we've been seeing it, probably if you got a Moderna one then Pfizer would be the one that would be more available.

If we could magically get all of these vaccines, would we then be going back to the recommendations from the manufacturers, down to the 21 and 28 days?

[Dr. Theresa Tam]

The National Advisory Committee on Immunization advised up to four months, but of course that can be adapted based on the evolving data but also supply.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Certainly, but the question I asked was about the mixing of vaccines. Of course the mRNA ones perhaps could be mixed—I'm not sure—when it comes to the second one or the booster shot that we're expecting later in the fall.

[Dr. Theresa Tam]

The current recommendation is that your second dose in a two-dose series should be with the same vaccine or from the same group or class of vaccines, so if you got an mRNA, you get the other mRNA, but there are studies right now in the United Kingdom. We're looking toward getting that data soon, we hope, and that would inform the Canadian strategy going forward.

Also, there is dose mixing, if you like, a mix of different classes of vaccines in Canada that's also being studied, planned and supported.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

It's good to know, as you said, that we were able to lead the world in expanding to the four months. It would be great to know that we're able to take that information on the mixing of vaccines, because people are going to be very concerned about it.

I saw yesterday that Albert Bourla, the CEO of Pfizer, said that a third COVID vaccine dose is likely needed within 12 months. I was just curious about what the procurement plans are as far as that is concerned. Is that 12 months from the time we get the second dose, or is that 12 months from when the first dose was administered?

[Bill Matthews]

Maybe, Mr. Chair, I can start on the procurement aspects, and I'll turn to health colleagues to talk about the duration or interval of the third dose to the extent that—

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

I am very interested in the health aspect of it, but yes, quickly go ahead on that.

[Bill Matthews]

Canada has bought more doses than we need for each Canadian, so there are those doses under contract as well as options for more. Obviously, as the science evolves, the vaccine manufacturers are working on, potentially, boosters, improved vaccines or adjusted vaccines because of variants, and we have ongoing discussions with those companies about what the next round of buying might be.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Thank you.

Again, I think the NIH has started testing a new COVID vaccine from Moderna, designed to protect against a problematic variant first found in South Africa. Do you have any knowledge about how quickly that particular vaccine might be available?

[Bill Matthews]

We are in discussions with the companies around the next round of buying. I can't speak to the timelines required to get through regulatory approvals, etc., but I suspect that my Health colleagues might be able to help there.

[The Chair, Liberal, Ron McKinnon]

We'll ask the Health colleagues, if they wish to respond, to do so.

[Dr. Stephen Lucas]

I'll just respond that from the perspective of any regulatory submissions we would receive for reformulated vaccine, be it for a booster or a second-generation vaccine, it would be subject to our rigorous review through the rolling review process. We would attend to that rapidly.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

From that perspective, there would be no concern for—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Dreeshen.

We'll go now to Dr. Powlowski.

Dr. Powlowski, please go ahead for five minutes.

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

I actually want to ask about the same thing—the interval between the first and second doses. Certainly, a lot of people are concerned about the interval. I have had health care people saying, “Look, we're high risk. Why are we getting only one dose?” I've also had concerned elderly people saying, “We're supposed to have the same dose after three or four weeks. Why is it longer?”

The evidence, certainly for AstraZeneca, seems to suggest that it's better if you have a longer interval between doses. With both Pfizer and Moderna, to my understanding, although I haven't looked in the last few days, the evidence was that starting at about three weeks, at least in young people, you had about 90% efficacy. The evidence from British Columbia, Quebec, Israel and the United Kingdom seems to be that for at least two months you have pretty good immunity. We have other vaccines where there are two doses and where it's six months in between. We have reason to believe that immunity is going to last for the full four months.

For someone like me, that's no problem. As somebody who still works a bit in health care, I've had my first dose. I'm not going to have my next dose for four months. The concern is more with the elderly, because studies seem to at least suggest that their immune response is poorer. The initial data from Israel suggested that one shot wasn't protective, although that seems to have been reanalyzed in that, well, a lot of those people were getting infected in the first two weeks, when no vaccine was going to work.

I want to ask the person from NACI what the current evidence is regarding the safety of that increased interval in elderly people and people who might otherwise be immunosuppressed, such as people on chemotherapy.

Thank you.

[Dr. Matthew Tunis]

NACI has certainly been reviewing in detail all of the emerging evidence on effectiveness in the elderly and also, as you mentioned, some immunosuppressed populations.

There are a few things that are important to establish. First, there is no correlative protection established for protection against COVID-19, as you're probably aware of. Many of these studies, the preprint studies, on certain immunosuppressed or solid organ transplant populations are based on antibody measures, and in some cases cellular responses, but not true effectiveness in the real world. It's hard to bridge those data over to real-world effectiveness. That's one thing the committee advised us in their report.

The second thing is with respect to the elderly. Much of the data that was reviewed by the committee early on in making their recommendations in fact came from long-term care settings and from the elderly. If we look at their analysis of what's been reported from the United Kingdom, where they were using an extended 12-week interval, for example, they found very good protection and very good effectiveness against severe outcomes—hospitalization and death—certainly above 80%. The effectiveness against symptomatic disease is lower, and we're seeing that reported, but the most critical outcomes are being very well protected.

Looking to Canada, the committee was reviewing presentations, as Dr. Tam mentioned, from Quebec and British Columbia. Both provinces, by the way, are doing weekly vaccine effectiveness monitoring. They're keeping a very close touch on how this is evolving. That's being fed back to NACI and the provinces and territories. We've seen in the range of 80% to 90% effectiveness in the long-term care setting in those jurisdictions, not only against severe outcomes but actually against PCR-confirmed COVID-19 infection.

It's a very strong evidence base, at this point, understanding that it's not out to 16 weeks. As Dr. Tam mentioned, we're getting up to the 10- to 12-week mark in Canada with no signs of deterioration, even in those elderly populations. The committee is watching carefully, but at this time was very comfortable to say that up to four months could be considered by jurisdictions, understanding that they may choose to shorten it for specific populations, based on their epidemiological context.

Thank you.

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

I have a quick question for Dr. Lucas.

Health Canada's approval of monoclonal antibody combinations, specifically the Eli Lilly bamlanivimab-etesevimab combination and Regeneron's.... Those applications for approval have been there since February, and growing evidence suggests that the combinations are quite effective in preventing the progression to severe disease. Obviously our ICUs are overflowing. The NIH is recommending, because of the American variants, that we use these in Canada—at least in Ontario. Bamlanivimab alone, it seems, would cover 90% to 92% of the variants in Ontario.

When can we expect to hear something from Health Canada on these other monoclonal antibodies? Can this be expedited given the situation, particularly in Ontario?

[Dr. Stephen Lucas]

As the member noted, the combination therapies involving bamlanivimab of Eli Lilly and of Regeneron and Roche are before Health Canada, the regulator. The submissions were received in February and are undergoing the expedited review process that I spoke of earlier, under interim order. I can't say when they will be approved, but scientists are working day and night to review the submissions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Powlowski.

It is now over to Mr. Thériault, for two and a half minutes.