Health Committee on June 18th, 2021

[Alain Lamarre]

Yes, I absolutely agree. That's an excellent point.

Doing basic research, as you say, means investing in the development of future technologies and stimulating innovations in healthcare. This is true for all fields, but particularly for healthcare. It is how new therapeutic avenues are discovered that ultimately lead to new treatments and new drugs.

Over the past decades, we have seen a downturn, even a decline, in research investment, and we have seen the potential consequences on vaccine development. The newspapers have mentioned that Canada has lost a lot of its reputation internationally in terms of its ability to develop vaccines.

I think it's time to reinvest massively in basic research so that we can rebuild our entire ecosystem and better position ourselves internationally.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Yes, the key word is “ecosystem”.

And since we are talking about the international side of things, yesterday, we learned that the eminent Quebec researcher and microbiologist Gary Kobinger left Quebec to head the Galveston National Laboratory at the University of Texas. The main reason is that money is not an issue and they have many projects over there.

When you see that underfunding over the last 20 years is putting pressure on our ability to avoid a brain drain, are you concerned about the future? What can we do to stop this brain drain and make us an attractive place for scientists again?

[Alain Lamarre]

It's a shame to see that. He's not the first, and he won't be the last, to leave Canada for positions with, say, a better funding opportunity in the United States or Europe. In recent years, we've seen a decrease in the number of highly qualified researchers, from about nine out of every thousand to eight out of every thousand. That's a considerable drop in the number of researchers working in Canada.

Funding opportunities are also more attractive in the United States. As I said, the U.S. invests about three times as much in research and development as Canada, and the best Canadian researchers are attracted to positions there.

Indeed, it's very worrying.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

In your speech, your second recommendation was to continue and increase federal investments in advanced research infrastructure through the Canada Foundation for Innovation.

Could you expand on that position, so that we can make sure that governments can invest more in these innovations and, in particular, in our universities?

[Alain Lamarre]

The Canada Foundation for Innovation, the CFI, is a fantastic tool that has been put in place in Canada. It allows us to acquire state‑of‑the‑art infrastructure to continue to be among the pioneers in basic research. However, there is always a risk that this fund will be reduced or abolished, which causes stress.

Also, the operation of these infrastructures is increasingly expensive, and the CFI does not pay for all of it. Therefore, it's important to increase funding for these infrastructures, but also funding that helps cover the costs of operating and maintaining them.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

In short, every research stakeholder must be funded.

[Alain Lamarre]

Yes, absolutely.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

You talked about the research and life sciences ecosystem.

On July 1, the reform of the Patented Medicine Prices Review Board, or PMPRB, will come into effect. Mr. Clark of the PMPRB told us that in five years, the board has never done a study to assess the impact of life sciences reform in Quebec and Canada.

Several witnesses, including representatives from Research Canada, told us that weakening the biopharmaceutical sector, which is a key link in the health sciences innovation chain, can be expected to have a negative impact on the entire chain in Quebec, including research institutes, teaching hospitals, contract research organizations and clinical trial centres.

Does that worry you, Mr. Lamarre?

[Alain Lamarre]

This is a complex issue. While I certainly understand the goal of lowering drug costs for Canadians—it's an important issue that needs to be studied—we need to look beyond the cost. We also need to look at the value of these innovative drugs and calculate the potential impact on research. You have to look at the whole picture.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Thank you very much, Mr. Lamarre.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Lemire.

We were going to go back to Dr. Powlowski, but I believe Dr. Silverman is on the phone with IT support.

Dr. Silverman, are you able to hear me?

[Dr. Michael Silverman]

Yes, I can hear you. The question is whether I'll be able to hear Dr. Powlowski.

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

Can you hear me, Mike?

[Dr. Michael Silverman]

Now, I can. That's great.

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

Perfect.

I want to start off by congratulating you. I think you did a very good job of making a very good argument that the COVID vaccine should be mandatory for health care workers, and perhaps there's a need for national leadership with recommendations on this subject, perhaps under the auspices of PHAC.

I want to switch to another topic, and that is the issue of whether or not we should be keeping schools open, given the number of COVID cases. You recently wrote a paper that I think was published in the Canadian Journal of Public Health, entitled “Ethics of COVID-19-related school closures”. You talked about the pros and cons of school closures and who ought to be making the decisions as to whether or not to keep the schools open.

Could you maybe summarize your conclusions in that paper?

[Dr. Michael Silverman]

Thanks.

The issue of school openings and closures has been highly debated. However, there is strong consensus that because of both the short-term and long-term developmental and mental health risks of missing in-person learning and the low likelihood of severe physical harm to children from COVID, the safest place for children is in school.

However, these considerations must be balanced against the health risks to teachers of in-person learning as well as the potential health risk to parents and the overall trajectory of community transmission. These are all medical questions. They involve triaging between various medical priorities and, therefore, are best decided by the medical officer of health.

I would differentiate these issues from political concerns such as business closures. In the setting of closing the economy, economic bailouts and mitigating strategies that involve the public purse can be employed, so the politicians have an important role in decision-making. In contrast, school closures are purely a matter of triaging health care priorities. No amount of economic bailout can compensate a child for changes in their long-term development.

Politicians are subject to community advocacy pressures, which should not impact decision-making on the best approach to maximize public health. Promises are commonly made that schools should be the last thing to close and the first to reopen. However, in practice, this doesn't happen due to strong political pressures by various advocacy groups. Data from the United States shows that with the same level of community transmission, states run by Democratic governors were much more likely to have closed their schools than states run by Republican ones.

Decisions about school closure should be apolitical and made by the public health system, with the same separation of decision-making as occurs with the justice ministry. This would assure that public health priorities remain paramount.

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

Thank you.

Now I will turn to one of my favourite topics, and I'm sure one of the whole committee's, and that is the issue of the use of monoclonal antibodies.

Dr. Silverman, are you using them at Western? Do you find them helpful? Why aren't more Canadians using them?

[Dr. Michael Silverman]

We are using them at Western, but we've been hamstrung by a couple of things. First of all, it's been very slow. There is one monoclonal available, which is bamlanivimab, a combination of monoclonals, which has just been approved by Health Canada but is still not available.

As we're getting more variants, we need these other options. They are available in the United States. They've been available for quite some time. They really help some people who are at risk of developing severe COVID due to severe underlying conditions.

They're not a panacea. They are difficult to administer, because they require IV therapy for people who are generally well at the time they need it but who are at risk of getting very sick.

We've found that it's extremely difficult to get a hold of, but the difficulties can be overcome. Health Canada's recent approval of the combination drug has quite honestly been very slow and very late. There are multiple other options available in the U.S. that are not being made available in Canada yet. With that development, we need rapid deployment of the drug so that people who need it can get it.

We also need the institution of infrastructure so that it can be administered on an outpatient basis rather than having patients come into the hospital to get it. Special outpatient facilities have been set up in the United States, which have enabled hundreds of thousands of people to be treated in the U.S. We do not yet have those in Canada.

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

What would be your response to people who say that we're getting lots of vaccines now so we don't need the monoclonals anymore? Is that the case, or will there still be an ongoing need for monoclonals and other forms of therapy in the coming months?

[Dr. Michael Silverman]

Because more and more people are getting vaccinated, the need will decrease somewhat, but it is by no means going away. Many people don't respond well to the vaccines, such as people with underlying immunocompromising conditions. We are seeing these people come down with COVID despite being vaccinated. We're also seeing people who have had only one dose of vaccine now getting sick with the new delta variant and other variants. That's going to continue to happen for some time. Those people are important, and we need to be able to service their needs to prevent their ending up in hospital.

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

Quickly, Mike, do you have any comment on what further we ought to be doing in terms of protecting health care workers globally?

We've both worked internationally in health care. Are health care workers in developing countries getting the vaccine and getting protected?

[Dr. Michael Silverman]

I have a number of colleagues across sub-Saharan Africa. They are all complaining about limitations in availability of vaccine. They say that the government says it's available, but when they go, the cupboards are bare. They have to wait for long periods of time for either the first dose or the second dose. Basically, the cupboards are bare in many of these places.

[The Chair, Liberal, Ron McKinnon]

Thank you, doctors.

We go now to Mr. Davies.

Mr. Davies, go ahead, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for being with us today.

Dr. Dumont, may I direct my questions to you? First, let me say for the benefit of all of the committee, how exceptional the Lu'ma Medical Centre is. It is an indigenous-led community clinic in Vancouver serving a primarily indigenous urban population. It is innovative and is delivering frontline primary care to people who largely don't access that. I want to congratulate you on your accomplishments to date.

Dr. Dumont, I wonder if you could describe in a little bit more detail for us what impacts you've seen over the past year and a half, since the pandemic started, on the client population, which is, I guess, primarily urban indigenous people. What can you tell us about those?

[Dr. Michael Dumont]

I'm so sorry, Don. I don't know if it's my connection or yours, but I missed the question.