Evidence of meeting #36 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was federal.
A recording is available from Parliament.
12:30 p.m.
Epidemiologist, Ministry of Health of the Slovak Republic
Thank you very much.
I have to confess I love Canada. I have many friends in Toronto, Edmonton and Vancouver, and I have travelled a lot of Canada in the past. I hope once COVID is over, I'll be back in Canada again.
12:35 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Rempel Garner.
From Vancouver, thank you, Mr. Pavelka.
We go now to Dr. Powlowski for six minutes.
May 10th, 2021 / 12:35 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Hotez, I spoke to you almost a year ago on convalescent serums. Sir, I don't know if you remember. I didn't know then that you were one of the authors of the bible. I've worked a lot of years in tropical countries and before I go, I always buy the most up-to-date Manson's Tropical Diseases, so I'm really impressed.
I think convalescent serum has been largely replaced by monoclonal antibodies. My understanding is that the United States National Institutes of Health now strongly recommends that these be used by high-risk people early in the disease. In the United States, if you get sick and you're high risk, you go to a website and the government directs you to where to go for your treatment.
In Canada, basically we don't use monoclonals. First, I want to get your opinion on that. Second, your government nicely surprised me, anyhow, with the Biden announcement that it would back the WTO waiver on intellectual property rights related to COVID. What is your response to that? Do you think it will work, and if you can answer quickly enough, I would like to also get Dr. Bogoch's response to both those questions.
Thanks.
12:35 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
I think the patent waiver could be useful. I have an article that just came out in Foreign Affairs this morning that basically says that the patent waivers are a good development but are insufficient to solve the problem because the problem with vaccines is that they are more complicated than small-molecule drugs. For instance, if you have the structure of an antiretroviral drug for HIV/AIDS, the likelihood is that you can bring together organic chemists and formulation experts and produce that drug; the only thing standing in the way is the patent. Vaccines are far more complicated. It takes years to know how to create and build vaccines and do it under a quality umbrella for quality control and quality assurance, having the regulatory authority in place. Just waiving patents will not be sufficient to solve this problem.
What we need is the help from the U.S. government to actually make a lot of vaccine for the world. Look at the scale that we're talking about. There are 1.1 billion people in sub-Saharan Africa, 650 million people in Latin America and about 500 million people in the smaller, low-income countries of Asia. When you add up those numbers times two doses, we're talking about five to six billion doses of vaccine. Where's that going to come from?
The mRNA technology is still new. It's a great technology—I got the Pfizer-BioNTech vaccine, and I'm grateful for it—but can we scale that up, and what will a patent waiver do for that? It's the same with the adenovirus vector vaccines, and we have our vaccine. For instance, with regard to our vaccine, we have Biological E. making a billion doses. Who's going to make the other four to five billion doses? I think there seems to be.... There's not an adequate foreign policy for producing vaccine at the scale that we need and in the time frame that we need. We really need it now.
We have the added problem, of course, that the whole game plan for the global vaccinations relied heavily on India to be the big producer between the Serum Institute and Biological E. Now those vaccines are not being exported because they're being kept within India, so it's like a domino effect and the whole thing is kind of falling apart.
I worry that there's not an adequate structure. The COVAX sharing facility was well-thought-out, but the vaccines simply aren't there right now. The key message, I think, for the Biden administration is this: “Thanks for the patent waiver. It's a good first step, but now what are you doing to do?”
12:35 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
I'm obliged at this point to notify the committee that the bells in the House are ringing. We require unanimous consent to continue. May I suggest to the committee that we carry on through the end of this first round? Is there agreement to do that?
12:35 p.m.
Some hon. members
Agreed.
12:35 p.m.
Liberal
The Chair Liberal Ron McKinnon
Dr. Hotez, I believe your answer was over.
Dr. Powlowski had asked Dr. Bogoch to step in on this.
12:35 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Maybe, first, quickly, I'll ask Dr. Hotez about the use of monoclonal antibodies and the fact that they're used widely in the States. We don't use them.
12:40 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
They both work by the same principle. The idea is that the convalescent serum provides virus-neutralizing antibodies, and the monoclonal antibody works that same way. The advantage of the monoclonal antibody, of course, is that there's better quality control, so you know exactly how much antibody you're providing. With the convalescent plasma, there could be enormous variability. That's why you're getting very inconsistent results, as well.
If you have very high titre levels of convalescent antibody, it could work quite well, but a lot of places don't adequately measure it, so there is all that variability. Of course, the problem with both of those products is that you have to give them very early on in the course of the illness, when you're still interfering with virus replication. Remember, there are two components to COVID-19. There's the virus replicating phase, and then there's the host inflammatory response. Once you delay and allow that host inflammatory response to continue, it's clear that the monoclonal antibodies and the convalescent serum are not working very well, so you have to give it early on in the course. It's certainly no substitute for vaccination.
I don't quite understand why monoclonal antibodies are not more widely available. In the U.S., too, there's been a problem. For instance, when my daughter-in-law got COVID-19, she was living in Arizona and wanted to get her monoclonal antibody, and the infectious disease attending at the medical centre there gave me a list of about a hundred criteria why she couldn't get it. They've made it so fussy and complicated and have limited the criteria so that, at least for the last few months—maybe it's gotten better now—it was almost impossible to actually get it used for anybody.
12:40 p.m.
Liberal
12:40 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
I would like to thank our witnesses from Slovakia for sharing their experience with us.
Doctor Bogoch, I watched you react when witnesses from Slovakia were intervening. What do you think of how we used tests here in Canada?
Why is there resistance to using PCR tests instead of rapid tests and tests that are better suited to daily life, for example?
Isn't there a lesson here that would help us improve our screening operations?
12:40 p.m.
Physician and Scientist, Toronto General Hospital and University of Toronto, As an Individual
I'd like to thank our friends and colleagues from Slovakia for discussing their tremendous innovation and work.
I completely agree with the sentiment that you suggest and with the sentiment brought up by Ms. Michelle Rempel Garner earlier. These are excellent tests that have been underutilized in Canadian settings. We have access to them; we just haven't deployed them as broadly as we should have.
I think there is some general confusion among many Canadians as to the difference between a diagnostic test and a screening test. The PCR tests are very good for diagnostics. If you get sick and you want to know if a person coming into the hospital or clinic has COVID-19, you'd use a PCR test. We're talking about rapid testing to help keep workplaces safe. An example was given earlier: I'd much rather use a rapid test to detect most of the people coming in who are positive for COVID-19 by using these rapid tests than detect zero people coming in by not using any rapid tests. It's kind of a no-brainer, and they have been underutilized.
What's very interesting in Canada is that the business community figured this out first. While many of us in the medical and scientific community were debating back and forth, the business community just quietly went ahead and started integrating rapid testing, and created much safer work environments. This was most impressive. Here in Ontario, John Ruffolo is a well-known local business leader. He started pushing this forward, and we were applauding him from the sidelines.
I completely agree that we could utilize these tests much more significantly. There's room to do so. Quite frankly, this virus ain't going anywhere; it's going to be around for a while. Even with mass vaccine efforts in place, we still need to create safer workplaces. Given the way that point-of-care rapid testing was described by our Slovakian colleagues, it is a very smart way to do this.
12:45 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
If I understand correctly, we will likely have to live with the virus. All these health measures, that are essential, but restrictive, are having a major impact on mental health and the economy.
When we want to relax the measures and start lifting the lockdown order, no matter how minimally or progressively, wouldn't it be best to use these tests?
12:45 p.m.
Physician and Scientist, Toronto General Hospital and University of Toronto, As an Individual
Yes, I would agree completely. I've spoken publicly on this. I've published in the academic medical literature on this. I think they are underutilized in Canadian settings.
There's certainly a much greater role for expanding the use of these tests. They're good. Again, you have to use the right test in the right place and interpret it in the right manner, but of course, I think in general they have been underutilized in Canada. There is plenty of room for expansion.
12:45 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Doctor Hotez, I would like you to say a few words about waiving the vaccine patent. Earlier you talked about the COVAX program, which allowed 53 million people to be vaccinated. That is not a lot when you consider that eight billion people need to be vaccinated. I would like your opinion on that.
Could you also tell us what your vaccine could add to the frantic race to the vaccine? At first, we noticed that the science was open and everyone was collaborating, but as soon as a solution was discovered, everyone retreated to their own corners. Some countries even withheld vaccines. I would also like to know what you think of that.
Could you talk about the impact that your vaccine might have?
12:45 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
Unfortunately, I missed the beginning of that question, and my French is just not good enough. Maybe the English translator could just briefly summarize the beginning part?
12:45 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
Well, one thing is that we actually did not file any patents for our vaccine. It's free and open to anybody who wants to scale it up and produce it. We do this for practical reasons, because the filing of patents is so expensive, and our biggest concern is access. We provide non-exclusive licence for our vaccines for just a minimal licensing fee, and then you have the opportunity to scale it up and produce it. We put everything in the public domain, meaning we publish every step of the way, so that nobody can actually block us either. It has worked very well for us for our global health vaccines for schistosomiasis and Chagas disease, and we've taken the same approach for COVID-19 vaccines.
Again, intellectual property for us is not the biggest barrier. It's the fact that most countries just don't have the resources and trained human capital to scale it up. That's why I say, with respect to waiving intellectual property around mRNA vaccines, do not expect that all of a sudden you're going to see lots of mRNA vaccines around. There is an enormous learning curve that's required in order to produce it. If you were serious about having other groups starting to make mRNA vaccines, you would have to ask the Pfizer and Moderna people who have the experience now in scaling this up to actually enter into plants with organizations to help them learn how to produce this at that large scale. That's why I say that waiving the patents could be useful in the long run and it may even have some short-term use, but if I were to rank the top five priorities right now for vaccinating the world, I don't even know that waiving the patents would be in the top five.
12:50 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
We'll go now to Mr. Davies.
Mr. Davies, go ahead for six minutes, please.
12:50 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Hotez, I know that the U.S. federal government developed a national vaccination plan. I think I recall seeing that last November. Can you briefly describe to us what that national vaccination plan looked like and what role the U.S. federal government played in developing that plan?
12:50 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
Well, unfortunately, in the last administration, the vaccination plan was mostly about providing and ensuring that there would be adequate supply of vaccine. That was clearly important, but it became clear when the new administration took over that the plan and the logistics were largely focused on making certain that the boxes of vaccine would be kept without temperature incursions and delivered via FedEx and UPS and all of those usual mechanisms.
It was good that it happened, but there was really not an adequate plan to vaccinate the American people. The initial plan relied heavily on pharmacy chains and some of the hospital systems, and I think they did the best they could, but especially in some of the low-income neighbourhoods across the U.S., they're pharmacy deserts, and there was no mechanism for vaccinating, especially in low-income neighbourhoods or even in a lot of rural areas.
I think that there the contribution of the federal government was to put a new plan in place in order to scale up vaccinations very rapidly. That evolved as well, because when the Biden administration took office, they said that they were going to deliver 100 million immunizations in 100 days.
That made sense, I think, in January, until we realized that the B.1.1.7 variant from the United Kingdom was accelerating as fast as it was. A number of us in the scientific community said, “Well, it's great that you made that commitment, but it's not adequate, and you're going to have to triple that.” That was I think one of the more impressive things about the administration in 2021: how they regrouped to triple the rate of vaccination. That's why we're doing so well. There was that all hands on deck....
We still have problems now, because we do have—
12:50 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Hotez, I have limited time, and I have a few other questions I want to get to, if I could.
12:50 p.m.
Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual
Okay.
12:50 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
You sort of anticipated where I was going. I know that early in his term President Biden made a series of changes to the plan he inherited. That included setting up federally managed mass vaccination sites and deploying armed forces personnel—I think even national guardsmen—to assist with managing them.
Can you describe the role the U.S. federal government played in actually delivering vaccinations?
