Health Committee on June 14th, 2021

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome to meeting number 44 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. I'd like to start by welcoming the witnesses.

Appearing as an individual is Dr. Steven Hoffman, professor of global health, law and political science at York University. Also appearing as an individual is Dr. Shirin Kalyan, adjunct professor of medicine, University of British Columbia, and vice-president, scientific innovation, Qu Biologics.

From the Canadian Association for Neuroscience, we have Dr. Shernaz Bamji, professor, and from the COVID-19 testing and screening expert advisory panel, we have Ms. Sue Paish, panel co-chair, and chief executive officer of the digital supercluster.

Thank you, all, for being here.

I will invite you to make a brief statement.

Just as an FYI, I have magic cards. I will display the yellow one, if I don't get too engrossed in your testimony, shortly before the end of your time. I will display the red card when your time is up. Do try to wrap up when you see that. You don't have to stop instantly, but do try to wrap up.

Thank you very much. We will start with Dr. Hoffman.

Dr. Hoffman, please go ahead. You have five minutes.

[Dr. Steven Hoffman, Professor of Global Health, Law and Political Science, York University, As an Individual]

Thank you, Mr. Chair, and thank you for the opportunity to appear before this committee as a private individual.

My name is Steven Hoffman, and I'm a professor of global health, law and political science at York University, where I direct the global strategy lab.

Today I'll speak about a collateral impact of the pandemic that I think this committee has likely heard less about, namely the significant damage this pandemic has caused for our global governance systems. That's bad for Canadians' health because there are increasing numbers of health threats that defy national boundaries and depend on international co-operation to be addressed: antimicrobial resistance, air pollution, climate change, microplastics, radiation, the list goes on.

Since Canada cannot tackle these transnational health threats alone, we are especially vulnerable to them as one of the most globalized countries in the world. That means that we have a special vulnerability to any weakening of our global governance systems and, as I'd argue, a special obligation to help strengthen them. Canadians' health depends on it.

To draw this conclusion, I will first point to the fact that our existing global governance systems are predicated on a model of independent sovereign nation states that dates back to the 1648 Treaty of Westphalia. This means we are literally using 17th-century social technology to address 21st-century threats.

This way of organizing ourselves might have worked when pathogens would cross continents over the course of decades, but today pathogens travel across the world in a matter of hours. It takes just 18 hours for a virus to fly from China to Toronto, where I'm based, and that includes a nice stop in Vancouver along the way.

Even more important than understanding what COVID-19 has revealed about our weak global governance systems is how COVID-19 is further breaking them. The reality is that trust is fundamental, yet today we are witnessing the greatest erosion of that trust that I've seen in my lifetime. I am speaking about the horribly inequitable global distribution of COVID-19 vaccines. Rich countries are getting vaccinated, while poorer countries have mostly been shut out. Of course, this is not new. Certainly for me, it brings back some bad memories of the HIV crisis 20 years ago when richer countries had access to antiretrovirals, while poorer countries went without. A whole lot of people needlessly died, and those who didn't became angry, distrusting and resentful.

I make these pointed remarks not as a critique of a particular government or even of a particular country. Rather, fundamentally, I blame our global governance systems, which are in desperate need of strengthening. Our current systems make it very difficult for elected governments not to prioritize the short-term needs of their citizens above others, yet considering this virus will continue to evolve and new variants of concern will continue to emerge, global vaccine inequity will lead to suboptimal health outcomes for Canadians, in addition to humanity more broadly.

Of course, there is some good news. Canada is not only leading the world in first-dose vaccinations, but we are also one of the most generous countries in pledging 100 million vaccine doses to COVAX as of yesterday. That's great, but I think it's also a sad reflection on our global governance systems when actions taken by Canada and its G7 peers can simultaneously be both generous and woefully inadequate at the same time. Even one billion vaccine doses from G7 countries means that just 5% to 6% of people in low-income countries will get vaccinated this calendar year. That means that as we prepare to go back to normal, nearly everyone in poorer countries knows that won't be their reality in 2021, and probably not in 2022 either.

Mr. Chair, we are witnessing and are active beneficiaries of one of the starkest injustices of our lives. Like with HIV, this injustice is breeding anger, distrust and resentment, both towards the global governance systems that enable it, as well as towards the people, like us, who benefit from it.

The consequences of this injustice and our broken global governance systems will be with us, Canadians, for decades to come. We will all be less healthy in the long term because of it.

Thank you again for the opportunity to appear before this committee.

I look forward to your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Hoffman.

We go now to Dr. Shirin Kalyan.

Go ahead, Dr. Kalyan, for five minutes please.

[Dr. Shirin Kalyan, Adjunct Professor of Medicine, University of British Columbia and Vice-President, Scientific Innovation, Qu Biologics, As an Individual]

Thank you, Chair, and thank you to the honourable members of the committee for the opportunity to speak this morning.

I'd like to start off by just saying that the thoughts I'm presenting are really my own as a translational immunologist, and not necessarily those that are shared by my affiliated organizations.

My focus today is really on two issues.

The first is the apparent lack of strategy we had of ensuring that Canadians have a diverse portfolio of the types of vaccines we have in our tool box at this time. We have definitely procured a good number of vaccines and this is fantastic, but they're all of the new gene delivery platform variety, and I'll be elaborating a little bit on that subsequently.

Second is our apparent neglect to consider sex differences in immune response to infections and vaccinations in our strategy for immune protection.

To understand the first issue, I will provide a brief overview of the three broad categories of vaccines.

The first is whole vaccines and these come in two flavours. First is the live-attenuated vaccine, which provides a really fulsome training for the immune system. The one infectious disease that we have successfully eradicated through vaccination, smallpox, was done using a live-attenuated vaccine. These provide longer lasting immunity and they typically don't require multiple booster shots. I would say these are the best options for young, healthy kids. However, they take quite a while to produce.

The second type of whole vaccine is the whole inactivated vaccines. These are fairly straightforward to make. They don't take very long at all. It's essentially the whole microbe that's killed in some way. We already have one that has been approved for emergency use for COVID-19 by the World Health Organization. These whole vaccines, because of their multiple epitopes, are theoretically really less susceptible to result in a loss of efficacy with variants or aid in variants selection.

The second category of vaccines is what we call component, or subunit, vaccines. They're made by selecting immunogenic parts of a microbe and formulating these with an adjuvant. You can consider them to be highly processed versions of a double inactivated vaccine.

We have a lot of experience using the above types of vaccines for generating immune protection. In fact, the first category we've used for centuries, which really makes it easier to make educated guesses about their effects and also anticipating any safety concerns we may have.

The third category is these new cool nucleic acid delivery platforms that we have rolled out, which deliver genetic material either in the form of DNA or RNA into our cells to make or express viral proteins. We have very little, to no, knowledge on the long-term safety and efficacy of many aspects of this particular technology, especially when these vaccines are given in multiple doses. Given this lack of experience, it is very difficult to make well-informed decisions regarding their use. We've seen this play out in real time during the pandemic.

Given the above, why are all the options Canadians currently have in our tool box for immune protection in the midst of a pandemic all based on a technology in which we have the least experience and which have never been approved outside of emergency use authorization? I think we need to understand that issue a little bit more.

That leads me to the second issue. Not only do we need access to a diverse portfolio of vaccines to de-risk our response to the pandemic, but we should really strive to understand which vaccines would best serve different populations with different risk profiles.

To this point, I'd like to bring attention to sex differences that have been largely ignored, despite a very long history of sex-discrepant outcomes to infections and vaccine-associated adverse effects. This would be a prime example in which the implementation of GBA+, for example, would be highly relevant.

We know cis men are known to be, on average, more susceptible to severe infections, and we've seen that in the COVID-19 mortality data. Cis women, on the other hand, have a much stronger immune response, and this more vigorous immunity is a double-edged sword. Being female is also the greatest predictive risk factor for many autoimmune diseases. Women also bear the brunt of experiencing more serious adverse events related to vaccination, and we've also seen that with the COVID-19 vaccines.

Of note, a study has shown that women receiving half the flu dose generate a higher level of immune response compared to men who receive a typical or standard dose of the vaccine.

Given this body of knowledge, we should, at minium I think, be requesting that sex-based dosing studies for these new gene delivery platforms be performed for both safety and efficacy.

Thank you again for your time and considering these issues.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to the Canadian Association for Neuroscience, with Dr. Bamji.

Go ahead, Professor, for five minutes please.

[Dr. Shernaz Bamji, Professor, Canadian Association for Neuroscience]

Good morning, and thank you so much for providing me with this opportunity to speak to you on behalf of biomedical researchers in Canada.

My name is Shernaz Bamji and I'm a neuroscientist and a professor at the University of British Columbia. I'm also the president of the Canadian Association for Neuroscience, but I'm here today to not only speak on behalf of my members, who are over 1,000 scientists doing brain research in Canada, but for all Canadian scientists doing biomedical research.

I'm here to request an increase in our investment of fundamental research in Canada. We all know that investing in research will diversify and strengthen Canada's economy and will create quality jobs, but really, over the past 18 months, after we've seen the world ravaged by the COVID-19 virus, it's clear that investing in biomedical research is of utmost importance for the health of Canadians and people around the world.

As you know, in Canada, discovery science is funded by three main granting councils, collectively called the “tri-councils”. We are requesting a one-time 25% increase in tri-council funding and a 10% budget increase every year until funding levels are commensurate with other G7 countries.

Since COVID-19 is front and centre on everyone's mind, I'll share with you a Canadian success story. It's a story of my colleague at the University of British Columbia, Dr. Pieter Cullis, who has had a long-standing career studying lipid nanoparticles, which is a technology that wraps DNA and mRNA in a type of bubble so that we can safely inject them into animals and humans.

He started working on this back in 1995, but he firmly believed that one day this technology could be important for delivering therapies to patients. Along the way, he established collaborations with companies around the world, including BioNtech, which you guys probably know is a company in Germany that worked with Pfizer to generate one of the COVID-19 vaccines. If you received the Pfizer vaccine, you received a vaccine that uses lipid nanoparticle technology that was developed right here in Canada. I hope you are proud, because I certainly am.

This is just one success story out of hundreds, because of the investment that Canada has made in fundamental, non-targeted research. I say “non-targeted” because we don't know what the next needs of tomorrow will be.

The fact is that Pieter was doing his research back when the success rate for funding projects was higher. In 2005, more than 30% of grant applications were funded. Today, fewer than 14% of grant applications are funded, and I can tell you, as the chair of a research panel at CIHR just last week, there are many outstanding research projects, projects just like Pieter's, that will not get funded and, therefore, not get done.

Much of the data is pointing the same way. Canada is the only G7 country whose investments in research and development as a percentage of our GDP have actually been going down steadily in the last 15 years. Canada is now second to last in the G7 with respect to research funding. Not surprisingly, given this fact, the number of academic researchers, like me, per 1,000 people in Canada has been going down since 2011.

To show you what we are up against, in 2017 the budget for the National Institutes of Health in the United States was $30 billion U.S., while the CIHR budget was $1 billion Canadian. They spend more than 30 times the amount we do on research, but our population is only nine times less.

While the 2018 federal budget announced a historic addition of $689 million to tri-council funding, for which we are incredibly grateful, it is little more than just half of what was recommended by the fundamental science review report, which was commissioned by the government in 2017. Without this critical increase in funding, we will not be able to compete on the world stage. We will not be able to contribute to the next global health crisis, like we did with SARS and COVID—and there will be a next time.

Canadian researchers are ready to put in the hard work and we now look to you to help fund this work.

Thank you so much for listening.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Bamji.

We go now to the COVID-19 testing and screening expert advisory panel.

Ms. Paish, go ahead, please, for five minutes.

[Sue Paish, Panel Co-Chair and Chief Executive Officer of the Digital Supercluster, COVID-19 Testing and Screening Expert Advisory Panel]

Thank you, Mr. Chair and honourable members, for this opportunity to speak about the testing and screening expert advisory panel's fourth report, “Priority strategies to optimize testing and quarantine at Canada's borders”, which was published on May 27.

As vaccination increases and as we see the number of cases in the third wave subsiding, it appears many regions are now stabilizing. It's an opportune time to start to consider the appropriate balance of measures to protect public health while also reopening our borders. Supporting economic recovery depends on enabling the movement of people and goods across the border, while at the same time being vigilant in protecting the health and safety of Canadians and limiting the risk of importing variants and viruses.

Managing borders is complex. Measures must be easy to understand, equitable, feasible and consider both the benefits and the risks of harm. The panel took all these matters into consideration in preparing the recommendations that I'm going to summarize for you today.

The panel reviewed the various scientific evidence and presented to the Minister of Health recommendations for border measures relative to five different groups of travellers: unvaccinated, vaccinated, partially vaccinated, previously infected and exempt travellers.

For unvaccinated travellers, we recommend a testing approach similar to what is currently in place, including a predeparture test—either a PCR test within 72 hours of departure or a rapid antigen test within 24 hours of departure—an on-arrival test and quarantine. In respect of the quarantine periods, the panel found sufficient evidence to conclude that a negative test seven days after a traveller has arrived in Canada provides the same level of protection as a negative test on day 10.

Given the high efficacy of the vaccines authorized by Health Canada, the panel recommended that fully vaccinated travellers need only to complete an arrival test for surveillance purposes but no quarantine requirements, with a proof of vaccination. This approach also provides an incentive to encourage Canadians to get vaccinated.

For the partially vaccinated traveller, the panel found emerging evidence that a single dose of vaccine provides effective protection against severe disease, but it does not guarantee against infection. Therefore, we recommend that the measures for this population include a predeparture test, an on-arrival test and quarantine until a negative test result arrives after departure.

For a previously infected traveller, the panel recommends an on-arrival test and quarantine until a negative test result after arrival is confirmed.

For exempt travellers, based on the data the panel reviewed, we recommend voluntary testing at both land and air borders, primarily for surveillance purposes.

The panel also made a number of additional recommendations to improve the simplicity and adherence to border measures, including aligning travellers who are arriving by air and land borders so that they are consistent, and discontinuing the requirement for non-exempt travellers to stay in a government-authorized accommodation while awaiting their on-arrival test result.

Similarly, the panel concluded that testing requirements that vary by country of origin should not generally be implemented for travellers entering Canada except under unique circumstances, because once a variant is detected, it is likely already present in many countries, including Canada.

The panel also noted the critical importance of quarantine adherence and recommends increased monitoring of quarantine and adherence to requirements for testing, as well as the prompt reporting of a positive test result to local public health authorities where individuals reside to allow an immediate follow-up from that local health authority.

In conclusion, I noted carefully the announcement recently that the government will be easing travel measures in a phased approach, including by reducing potentially the testing and quarantine requirements for vaccinated travellers. Taking a phased approach to implementation aligns with the panel's view that changes to border measures need to be incremental. They need to be carefully evaluated in the context of increasing experience and data, the global situation regarding variants of concern and new evidence that might emerge as vaccination continues to increase.

Thank you for your interest in this work. I'd be pleased to take any questions from the committee.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Paish.

We will now start our questions.

Ms. Rempel Garner, please go ahead for six minutes.

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

Thank you, Chair. I'll be directing my questions to Ms. Paish.

First of all, thank you so much for the work the panel did. It was very important in moving the country forward. I have a few questions for you with regard to the report itself.

On what date did the panel complete the report, “Priority strategies to optimize testing and quarantine at Canada's borders”, and on what date was it submitted to the government?

[Sue Paish]

Thank you for the question.

This is our fourth report. We initiated our work on the report in late February, and we consulted very broadly, listening to industry groups and medical experts, as well as a variety of experts in other fields. We delivered our report to Health Canada on May 2. They serve as our secretariat for the panel. That's when we, as a panel, concluded.

After that, there was a period in which officials went through processes to evaluate and get the report ready to publish, including things like—you know this more than I do—translation, and things like that.

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

Thank you. I have limited time.

[Sue Paish]

I'm sorry.

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

It was submitted to the government on May 2. That would mean that the quarantine hotel provision was extended on May 21, after the government had received the report advice. Would that be correct?

[Sue Paish]

We met with the FPT—the federal-provincial-territorial—health ministers on May 10, which is part of our normal process to receive their input. We were still getting that final input on May 10, and then the report was published on May 27.

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

I notice that the government has chosen not to enact the recommendations of the panel in the first instance. Are you aware of any other data that the government would have received to inform their current approach to, for example, the quarantine hotels?

[Sue Paish]

We don't know what sources the government has beyond our panel that it takes into consideration, but we do know that there is a lot of information and a lot of data and evidence in areas that impact borders that are not within the purview of our panel. Our panel is just focused on testing and screening.

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

Sure. Are you aware of any other data that the government would be looking at on testing and screening that would be informing its decision to keep the status quo?

[Sue Paish]

We're not advised of the other sources that the government considers. We look at a very broad base of evidence, but there are other things that have to come into consideration in opening the borders.

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

Have you gotten any input from the officials as to why they haven't chosen to enact your recommendations?

[Sue Paish]

Once we file our report, the report stays with government. We've not had further engagement at this point in terms of their considerations. We did note in our report very clearly that the evidence and data is evolving rapidly. We were starting this report while the third wave was on its increase, if you will, and we all know that things have changed a lot since mid-February. We know that there's a lot there, but we haven't heard.

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

Is there any reason that you would speculate on as to why the government has not chosen to enact your recommendations?

[Sue Paish]

I'm not good at speculating, so I think I'll pass on that.

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

Is there any data that you could cite that would support the government's decision not to enact your recommendation?

[Sue Paish]

As we understand it, the government is certainly exploring elements of our report for implementation. I'm not aware that they are not implementing the report. I think one of the critical elements of our mandate is that borders be done in a measured, a very cautious and a phased way because there are multiple elements that need to be considered. The information that we have, which is what we have in the public domain in terms of the reopening—