Health Committee on May 10th, 2021

[The Chair, Liberal, Ron McKinnon]

I call this meeting back to order.

Welcome, everyone. We are resuming meeting number 36 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic. Specifically today, we're examining Canada's national emergency response landscape.

I'd like to welcome the witnesses. We have, as individuals, Dr. Isaac Bogoch, physician and scientist, Toronto General Hospital and University of Toronto; and Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine.

From the Ministry of Health of the Slovak Republic, we have Brigadier-General Dr. Vladimír Lengvarský, Minister of Health of the Slovak Republic, and we have....

Is it Dr. or Mr. Martin Pavelka, epidemiologist?

[Martin Pavelka, Epidemiologist, Ministry of Health of the Slovak Republic]

It's mister.

[The Chair, Liberal, Ron McKinnon]

Okay, thank you. Mr. Martin Pavelka, epidemiologist.

With that, we will ask the witnesses to present their statements. I will display a yellow card when your time is almost up and a red card when it's up. When you see the red card, do please try to wrap up.

We'll start with Dr. Bogoch for six minutes.

[Dr. Isaac Bogoch, Physician and Scientist, Toronto General Hospital and University of Toronto, As an Individual]

Thank you so much. Again, thank you for the invitation to chat today.

My name is Isaac Bogoch, and I'm an infectious diseases physician and scientist based out of the Toronto General Hospital and the University of Toronto. I sit on several provincial and federal COVID-19 committees and task forces.

Over the next few minutes, I'd like to focus on a few semi-related issues related to the pandemic response. I think it's important to frame our conversation within the current and the near-future Canadian context.

We're still embroiled in a pretty large third wave across most of the country. Provinces such as Nova Scotia and Alberta, unfortunately, have higher rates of infection than ever before, but other provinces are slowly turning the corner.

No matter what, we're far from where we need to be. With mass vaccination efforts expanding, I think it's fair to say that we're going to realize some significant benefits from this vaccination, much like other countries that are a few months ahead of us, like the United States, Israel and the U.K. We're just a couple of months behind them. With sound public health measures and ongoing vaccinations, we will likely be far better off in the near future than where we are right now.

With that in mind, I think it's important to focus on a couple of current and near-term issues, and to really start thinking about what our off-ramp looks like.

The first one is regarding border measures. Now, we know COVID-19 isn't going anywhere any time soon; it's going to be around for awhile. At least for the near future, I think it's reasonable to ensure that people travelling, and Canadians returning to Canada, demonstrate either evidence of COVID-19 vaccinations, or if people choose not to be vaccinated, they still must quarantine and show evidence of negative testing.

This virus poses a significant public health threat, and we know it disproportionately impacts our low-income and racialized neighbourhoods. Border measures like this won't be perfect, but they'll still reduce the importation of virus. Policies like this seem prudent for the near future. Longer-term strategies remain unclear.

Related to the border, I think it's also important to discuss vaccine passports. When I say “vaccine passports”, I'm referring to requiring evidence of vaccination to cross an international border. Regardless of what our personal views are of the virus or vaccinations, there's a growing list of countries globally that require proof of vaccination for COVID-19 to enter them. We should be proactive in ensuring that Canadians who choose to be vaccinated will have acceptable documentation of their vaccine status to enable international travel.

Another point is with regard to essential workers who cross the border. We know there are tens and tens of thousands of people crossing our borders daily, and many of them are essential workers, such as truck drivers bringing in vital goods to Canadians. They should have priority vaccinations. For example, we know there's a great program on the Manitoba-North Dakota border for vaccinating truck drivers. This program is exemplary, and we should see more of that.

I have a couple of other quick points.

With regard to airports, if we were going to shut down all non-essential travel to the country, the time to do it was over a year ago. The current measures are clearly not perfect, but they still buffer Canadians from importing a significant number of cases of COVID.

When we look at the current and projected pace of vaccination and the benefits afforded by vaccination, I think it's pretty clear that there are significant questions when we raise the utility and costs of further restricting already restricted travel versus the potential gains. We could also create safer travel by ensuring that those who enter the country are vaccinated and continue to quarantine, as mentioned above.

Lastly, to touch on the Emergencies Act, or other measures for federal intervention at the provincial level, a lot of this is easy to say, but I imagine it's much more challenging to operationalize. I don't think there's the capacity for the federal government to micromanage health care or public health at the provincial level, or even regional level. There would have to be very, very clear and prespecified divisions of labour to make this work effectively.

There are plenty of other COVID-19-related topics to discuss, but unfortunately I don't have a lot of time. I'd be happy to address any of these in the question period that follows.

Again, thank you for your time. I'm happy to chat.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Bogoch.

We will go now to Brigadier General Vladimír Lengvarský.

Sir, go ahead with your statement, for up to six minutes, please.

[Brigadier-General Vladimír Lengvarský, Minister of Health of the Slovak Republic]

Thank you.

Dear Mr. Chairman, vice-chairs, members of the standing committee on health, dear friends in Canada, I would like to extend my cordial greetings from Bratislava to all of you. I'm pleased and honoured to have this opportunity to address you. Likewise, allow me to convey my special thanks to the Honourable Michelle Rempel Garner, a great friend of Slovakia, for the invitation to share the Slovak experience with nationwide population testing.

The current pandemic is a humanitarian crisis that is threatening to leave deep social, economic and political scars for years to come. It is therefore highly desirable and responsible to adopt corresponding strategies that have the potential to relieve impacts of the pandemic.

Before the introduction of the vaccines, the testing itself was the only efficient tool for countering the pandemic. In this context, Slovakia opted for nationwide testing, which has proven to be helpful in revealing the areas hardest hit by the virus as well as in reducing the rate of incidence. This information was crucial for preparing and adjusting the corresponding region-based measures.

Overall, I perceive that it's extremely important to build synergies at the international level, including through sharing examples of best practices. Let me thank you once again for your interest in the Slovak experience related to testing. Mr. Pavelka is ready to provide you with further information on this matter.

Stay healthy and keep safe. Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Minister. I'd also like to acknowledge the presence of the ambassador, Vit Koziak.

Welcome and thank you.

We don't have Dr. Hotez yet, do we? There we go. Okay.

Doctor, could you say a few words for the interpreters, to make sure they can hear you properly? Then I'll ask you to start your statement.

[Dr. Peter Hotez, Professor and Dean, National School of Tropical Medicine, Baylor College of Medicine, As an Individual]

It's good to see everybody, and I appreciate this opportunity.

[The Chair, Liberal, Ron McKinnon]

Could you say maybe a few more words?

[Dr. Peter Hotez]

I hope everything is working out well and that I can be understood for the translation.

[The Chair, Liberal, Ron McKinnon]

That's excellent. Thank you.

Mr. Clerk, is that sufficient? I'm getting the thumbs-up.

Please go ahead, Doctor, for six minutes.

[Dr. Peter Hotez]

Thank you to the committee for inviting me.

Very briefly, I'm an M.D. Ph.D. pediatrician-scientist and I co-lead efforts to develop vaccines for neglected diseases of poverty in addition to coronavirus infection vaccines and a new COVID-19 vaccine. For the last two decades, we've built an academic research centre known as a PDP, a product development partnership, and we use industry practices to make the pharmaceuticals that industry generally won't produce because they mostly target diseases of the poor.

Our PDP is know as the Texas Children's Center for Vaccine Development at the Texas Children's Hospital and Baylor College of Medicine. We've now developed a low-cost recombinant protein vaccine to prevent COVID-19. Some refer to it as a people's vaccine because it could be scaled for production at extremely low cost, we think as low as $1.50 U.S. per dose, and it requires simple refrigeration. Biological E., one of the big vaccine producers, has now started to scale up production to more than one billion doses, and the Indian regulatory authority has now given us the green light to advance it to phase 3 clinical trials with the hope that there will be an emergency-use authorization in India later this summer. In parallel, CEPI, the Coalition for Epidemic Preparedness Innovations, is working with Biological E. for a global road map for phase 3 trials internationally.

There's just one other biographical piece. I do have a meaningful Canada connection. My grandfather Morris Goldberg grew up in the Jewish quarter of Paris and emigrated to Montreal around the time of World War I. Years later, he lost many family members during the Nazi occupation of Paris, so I always like to say that I exist only because of the goodness of the Canadian people who accepted my grandfather, and I've never forgotten that.

Today, I hope to raise two issues, one on COVID-19 vaccinations and the other on COVID-19 vaccines. With regard to vaccinations, according to the New York Times tracker, as of yesterday, only 3.2% of Canada's population has been fully immunized, and just under 40% has received a single dose.

In contrast, in the U.S. the numbers are 34% fully immunized and 46% having had a single dose. In the U.S. we also do have our problems though. We have a troubling blue- and red-state divide so that the real situation is that states such as Vermont, Massachusetts and Connecticut will reach the point where almost one-half of their populations are fully immunized, whereas deep red states such as Idaho and Wyoming and the mountain area in our southern states are only about one-quarter in. This disparity reflects an awful level of anti-vaccine aggression in our country.

[The Chair, Liberal, Ron McKinnon]

Pardon me, Doctor, could you slow down a little for the interpreters.

[Dr. Peter Hotez]

Okay. I'm sorry about that.

I'm also a bit of an expert on this anti-vax scenario because my youngest daughter, Rachel, has autism and intellectual disabilities, and I wrote a book previously called Vaccines Did Not Cause Rachel's Autism, which often makes me public enemy number one with the anti-vaccine group.

Regarding Canada, I've publicly expressed my concern that our U.S. government could, and should, do more to help Canada vaccinate its population, especially now, given that only 3% of Canadians are fully immunized. In my public appearances on the cable news networks and podcasts, including the CBC, I've explained why there are both practical reasons and emotional reasons for this.

On the practical side, we share an enormous border. We simply cannot slow transmission by vaccinating all of Detroit, Michigan, for instance, without doing the same in Windsor, Ontario, or Buffalo, New York, on either sides of the Peace Bridge.

On the emotional side I've stated that there are not many nations who showed the United States unconditional love—and here I recount my remembrance—in the days after the 9/11 attacks when 100,000 Canadians stood on Parliament Hill in solidarity with the American people. I would point out not many nations do such things. I've therefore stated that when it comes to providing immunizations against COVID-19, there should be no daylight between the U.S. states and the Canadian provinces.

Specifically In the area of vaccines, I also believe that Canada has the potential to do more in vaccine science and production. You're a nation of some of the world's greatest research universities and medical schools; people come from all over the world to train at UBC, Toronto, McGill, Queen's, Waterloo, Western, Alberta, just to name some. Ultimately it was the Public Agency of Canada's National Microbiology Laboratory that led to the development of the successful Ebola vaccine that stabilized the situation in the Democratic Republic of the Congo.

Our licence to Biological E. in India is not exclusive, and we'd be more than willing to transfer our technology to Canada so we could produce it for the world, if not for internal use. This might be part of a larger opportunity for the NML, the National Microbiology Laboratory, possibly in collaboration with one of Canada's research universities, to build a world-class centre for vaccines, science, development and production, doing so would propel Canada to the forefront of global vaccine diplomacy.

Thank you again for this opportunity, and I look forward to having a discussion and dialogue and answering any questions you might have.

[Chris d'Entremont, Conservative, West Nova, NS]

On a point of order, Mr. Chair, I think Mr. Pavelka had some further comments to go with the Slovak presentation, so if you wouldn't mind.

[The Chair, Liberal, Ron McKinnon]

Absolutely, I apologize.

Mr. Pavelka, I apologize, please go ahead.

[Martin Pavelka]

Dear Mr. Chairman, vice-chairs and honourable members of the Standing Committee on Health, and dear friends in Canada, it's a great opportunity to present to you the Slovak experience of rapid antigen mass testing and how it can be effectively used to suppress COVID prevalence in the population.

In the next few minutes, what I want to do is convey three key messages and present the Slovak experience, bust some myths about antigen tests and mediate the message on how to conduct effective, efficient and practical rapid antigen mass testing.

From the Slovak experience, for us, PCR testing actually was not the best test for the COVID-19 epidemic, for several reasons.

The first one was the time lost in processing. By the time you got a time slot to be able to go to a mass testing centre, the laboratory processing time or the time lost was just an opportunity for the virus to produce new generation lines.

Second, the limited laboratory capacity meant that only symptomatic people were basically favoured for the PCR tests. On the other hand, for the antigen tests, you can scale them up, and because of the low cost you can do them at high frequencies and you can actually cut more strains of transmission.

I'm going to give you some basic data about our antigen tests. Between January and April, through antigen testing, we detected almost twice as many infections as through the PCR channel. There were 250,000 infections detected in this short time period. That is 5% of Slovakia's population. Half of these infections were completely asymptomatic at the time of testing. These people would never have been detected through standard syndromic PCR surveillance.

One in 20 people were detected through antigen tests, so more or less everyone in Slovakia now knows someone from their close circle who was detected through antigen tests and who, through timed isolation, was able to basically prevent infecting their parents, their friends and their loved ones.

Slovakia did three main mass testing campaigns, one in November and then again from late January onwards. Now, every week, Slovak residents are tested, and the tests allow them to use exemptions from the stay-at-home order. You can go to work and you could go to the post office, the bank and so on.

The methodology was basically laid out by Michael Mina and Daniel Larremore. I call them the fathers of rapid antigen testing. Slovakia was one of the very first countries to actually conduct tests in cycles, so I call them the poster children of the antigen mass testing.

In our dataset, the specificity of the test is actually really massive. From a low test prevalence in our symptomatic counties, we could calculate that the specificity of the antigen tests used in our country is no less than 99.96%. From the 30 million antigen tests conducted during this period, no more than 12,000 were false positives, so really, when it comes to specificity, the false positive tests are not of concern.

When it comes to sensitivity, the tests in Slovakia have proven to very well detect infectious individuals. As I said, with the PCR test, by the time you are actually confirmed to be infectious, you may not be infectious anymore. With these antigen tests, we are in fact [Technical difficulty—Editor] infectious people.

As a very final point, there are three key messages or ingredients from our own experience that make a rapid antigen mass testing campaign so successful.

First of all, it's the volume. Other countries have tried it. In Austria, for example, Vienna tried it and it didn't work; only 5% of the population of Vienna turned out. That's not enough to cut transmission chains so you can flip the reproduction number below one. Regularly, one-third of the population gets tested every week. This seems to be working.

Second is communication. One of the misconceptions is that people don't trust antigen tests because of their lower sensitivity. Now, the point of rapid antigen mass testing is not to accurately detect the infectious status of every resident. That's not the point. It's not a clinical test. The point is to detect enough strains of transmissions, and by cutting them, you are flipping the reproduction number to below one. That's all you need. By switching that, the epidemic will be decelerating.

Communication is very important. The rapid antigen mass testing only works when you communicate the messages very clearly to the population.

Finally, the most important ingredient from our dataset is that we learned it's not enough to isolate the positive case, but to isolate the whole household. That's because of the secondary attack rate of the virus. Once it gets into a household, the member of the family will effectively infect the rest of the household members, so you need to isolate the whole household

Thank you very much. I'm ready to take questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Pavelka.

We will go now to our questions, starting Ms. Rempel Garner for six minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

I'll briefly start with Dr. Hotez.

I want to thank you for your work in vaccine advocacy and dispelling myths around the vaccine link with autism. I think it's really important, and I want to thank you for doing that.

I am going to direct most of my questions to representatives from Slovakia.

You have the benefit of three members of this committee having been to Slovakia.

The national story of rapid testing is one that really should be celebrated internationally. I think it probably saved a lot of lives, and it's one that, in Canada, we're very interested in, particularly as we wait for vaccine shipments to arrive in Canada.

Mr. Pavelka, I'll start with you.

I read your study called “The impact of population-wide rapid antigen testing on SARS-CoV-2 prevalence in Slovakia”, which found that multiple rounds of population-wide rapid antigen testing decreased COVID-19 prevalence by 58% within one week.

Can you explain, and elaborate perhaps, on how that rapid testing was able to achieve this?

[Martin Pavelka]

There is a slight difference between the November campaign and the current mass testing we're having now. The one key difference is back then, we didn't have the B.1.1.7 strain. Now, almost 100% of our positive samples are B.1.1.7, which is more transmissible. We are not actually achieving 58% suppression of prevalence between each round, as we did in November, when we were still dealing with the old variant.

It's still measurable. We have the same vaccine coverage as all the other members of the European Union, yet we have one of the lowest infection rates and were one of the first countries to actually get to almost the bottom very rapidly.

The key success behind that is, as I said, isolating households. When isolating the household, you're effectively cutting the chains of transmission. Especially with the B.1.1.7 strain, what we've found is that when a member of the family gets sick, the whole family eventually develops symptoms; whereas with the old Wuhan type, or the pre-existing variants, the secondary attack rate was around 20% or 30%. Now, literally the whole household gets sick.

By isolating just the positive case, you will not cut the transmission effectively. By isolating the household—

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you. I'm sorry to cut you off. My time is brief.

The other thing that was really interesting about the work that came out of Slovakia was showing the amount and the prevalence of asymptomatic cases, which likely had a significant cause of spread in many parts of the world.

In countries like Canada, we have had stay-at-home measures, and certainly in the early start of the pandemic, there may have been asymptomatic spread, but it wasn't necessarily detected. Then, I think there was this thought that, well, in the population, everything is fine, right?

Do you think there was a bit of a positive sociological impact, as well, on rapid testing? For example, when you tested the whole population, you were able to show that there was spread and this was something that the country needed to take seriously.

Do you think that perhaps helped compliance with the stay-at-home measures, and then subsequently with a desire for vaccination?

[Martin Pavelka]

This was the case in the November campaign.

Back then, we didn't test over a period of a week, but we did one round in one single weekend and then repeated it again. In those two weekends, we detected around 50,000 or 52,000 infections. This was taken by massive surprise. No one expected that, and I think that's when it hit everyone: It is everywhere, and anyone can be a carrier.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

The other thing I would note is that I think testing is so important. You talked about myth busting. I've heard many times that PCR tests are the gold standard and that antigen tests are less accurate. But your experience has shown that the volume of the testing—testing everybody regularly—helps to stop the spread of COVID because you're catching many more cases than you would by just PCR testing symptomatic persons.

[Martin Pavelka]

Absolutely, it's exactly as you said. It's an old Soviet/hammer method, I agree. But how many PCR tests have we had? Maybe we in the government have them more often because we are exposed to many international meetings. But the ordinary citizen may have one or two PCR tests in a year. With the antigen test, you can ascertain your infectious status every week—twice a week. And this is the problem with SARS-CoV-2, because a large portion of the population is fully asymptomatic. These people would never know they are infectious. By taking the antigen test once or twice a week, I can search my infectious disease. I can find out if I am positive or not. If I'm positive, I can isolate myself much earlier to prevent new generations or propagation lines of the virus, and if I am negative, I can go to work and can send my children to school.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

With the few remaining seconds I have left, I do want to congratulate Slovakia for your excellent work. Once I am fully vaccinated and travel is safe, I certainly look forward to visiting your beautiful country and seeing friends and family there again, so congratulations. I think there are a lot of best practices we can take as a country from your efforts in rapid testing.