Health Committee on June 7th, 2021

[Don Davies, NDP, Vancouver Kingsway, BC]

Who should answer, then, Dr. Tam, if you can't answer? Who's best placed to answer that question as to why we're ignoring that?

[Dr. Theresa Tam]

I would suggest Dr. Lucas.

All I would say is that when a regulator accepts a manufacturer's submission and data on extension of shelf life, that is reviewed by the regulator. When the regulator approves of that, the vaccine then is not considered as expired; so I think that's a regulatory issue.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Lucas, can you tell me why Canada is at odds with what the WHO is recommending?

[Dr. Stephen Lucas]

I would simply say that there are no expired doses being used in Canada. Health Canada received a submission in late May from AstraZeneca seeking a one-month extension on the doses that were to have expired on May 31. Health Canada scientific reviewers reviewed in detail the data provided and issued a regulatory decision extending those doses to July 1.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Dr. Tunis, many Canadians have received their first dose of AstraZeneca. Many of them are now coming up for their second dose. Most provinces, if not all of them—I'm not sure—are not using the drug due to VITT concerns and supply issues. Of course, the mixing data, using AstraZeneca with messenger RNA vaccines, is apparently not conclusive to this day.

What is NACI's recommendation to Canadians who received their first dose of AstraZeneca on what they should be taking for their second dose? Should it be AstraZeneca or should it be a messenger RNA vaccine? What data is that answer based on, please?

[Dr. Matthew Tunis, Executive Secretary, National Advisory Committee on Immunization]

NACI published new advice, as of last week, on the topic of mixing vaccine schedules. NACI has now recommended that either AstraZeneca COVID-19 vaccine or an mRNA COVID-19 vaccine product may be offered for the subsequent dose in a vaccine series started with AstraZeneca. Either may be offered.

The evidence that was used by the committee to issue that recommendation included both safety evidence and evidence on the immune response. There were several studies at the time, one from the United Kingdom, one from Germany and one from Spain. All of them reported a good safety profile when vaccines were mixed between AstraZeneca and mRNA vaccines. There was also one study on the immune response from Spain. I'll note that a number of studies came out preprinted last week as well, two from Germany, on the topic of immune responses when vaccines are mixed.

The committee has made that recommendation based on the risk of VITT, or thrombosis with thrombocytopenia, after first and second doses of AstraZeneca. They also considered the possibility of increased short-term reactogenicity with a mixed schedule and emerging data on the immune response from that mixed schedule that I mentioned. That was all—

[Don Davies, NDP, Vancouver Kingsway, BC]

Can I just interrupt, Dr. Tunis, and put something to you? Last week Dr. Andrew Morris expressed concern that individuals cannot really receive informed consent regarding the risk of VITT prior to getting a second dose of AstraZeneca, given the constant changing data being received about the incidence of VITT. He had numbers showing that it's continually changing.

Although there's emerging data, is there conclusive data, at this point, to make an informed decision on the safety concerns of AstraZeneca or on mixed dosage? Or is that data shifting and moving?

[Dr. Matthew Tunis]

That is an excellent point. I would say that with many data elements in this pandemic and the vaccine responses, that does continue to shift. Yes, on the risk of VITT following AstraZeneca vaccine, we have seen that change over time. It does continue to change. That informed consent process would ideally include a discussion about what is known and also the fact that it has been changing over time. NACI has acknowledged that in their advice to the government, namely, that informed consent should include discussion of that, which does change.

On the topic of the mixed schedules, those are being implemented in a number of countries around the world. The evidence is emerging and will continue to emerge over months as more studies come out exploring that topic, but a number of studies were reviewed by NACI when making this advice, and they continue to emerge.

Again, on the topic of mixed schedules, NACI felt very comfortable recommending, as many other countries have now done, that mRNA vaccines can be used to complete that series. Yes, they acknowledge that the evidence does continue to change and to evolve. We may learn more about whether a mixed schedule does in fact generate a stronger immune response. Those things continue to emerge.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Thank you, Mr. Davies.

That brings round one to a close. We'll start round two with Mr. Maguire.

Mr. Maguire, officially you have five minutes. We'll give you five minutes and 45 seconds because of my—

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thanks very much, Mr. Chair.

I want to ask Dr. Lucas some questions here.

The contract with Switch Health to oversee post-arrival coronavirus tests for travellers has been renewed, despite media reports that the company has bungled the process. I've raised this a number of times in our meetings in the past.

What communications did your department have with the Government of Ontario about an RFP for post-arrival testing?

[Dr. Stephen Lucas]

Mr. Chair, I'll turn that question to Iain Stewart from the Public Health Agency.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Lucas, are you not in charge of that?

[Dr. Stephen Lucas]

In terms of the work on the border testing, that is the responsibility of the Public Health Agency.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Yes, I've been in touch with them many times.

Mr. Stewart, go ahead.

[Iain Stewart]

Hello, sir. How are you today?

Thank you for the question.

The contracting aspect would probably be better placed with Bill Matthews, but with respect to Switch Health, as you point out, they are a service provider of the Public Health Agency.

[Larry Maguire, Conservative, Brandon—Souris, MB]

I just asked what communications your department had with the Ontario government about the post-arrival testing.

[Iain Stewart]

On the renewal of the contract for post-arrival testing?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Yes, the RFP.

[Iain Stewart]

Yes, that would be for Bill Matthews.

[Bill Matthews]

Thank you, Mr. Chair.

There have been no direct discussions with the Ontario government that I'm aware of, but I'm happy to check to see if—

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thanks. What communications did your department have then, Mr. Matthews, with the Government of Ontario prior to the RFP being given to Switch Health?

[Bill Matthews]

The federal government ran its own procurement process for the testing, and Switch was the recipient of the contract. I'm happy to go back with my staff to see if there was any contact with the Ontario government, but I'm not aware of any. I'm happy to take that back and see if there were others.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Did Switch Health ask anyone in your department to change the day-10 test to a day-8 test?

[Bill Matthews]

No, sir.

[Iain Stewart]

Excuse me for jumping in, Mr. Chair and honourable member.

That was an operational decision made by the public health officials.