Health Committee on March 23rd, 2022

[Dr. David Jacobs]

We've learned that vaccines work. Public health interventions work. Masking works. We generally have a very compliant society. We have a society that cares for its neighbours. We have a society that cares for the health of the elderly. We have been very compliant, both in getting our vaccines and in getting our booster shots.

I want to take this away from the basic science research and bring it back to the clinical world. When you have your vaccine, if you do get COVID, you do not get as sick. If you are unvaccinated, you are disproportionately going to get extremely sick.

By our ability to counter misinformation and by caring for our neighbours, as Canadians are known to do, we have been able to keep our death rates much lower. The vaccines have been a medical miracle. The fact that we got them as soon as we did is fantastic. They did exactly what we needed them to do.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. Jacobs.

Do I still have some time, Chair?

[The Chair, Liberal, Sean Casey]

No, you don't.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ms. Langlois and Ms. Lelièvre, in a December 6, 2021, article, Mr. Fabien Paquette of Pfizer Canada says that, according to the industry, lifting the patents “...is more likely to generate undue pressure on demand and already tight raw material management, limit production capacity for highly efficient sites, and discourage the innovation that has served us so well in the development of vaccines in record time.”

What do you think of this kind of argument?

[France-Isabelle Langlois]

This is an argument typical of multinationals and pharmaceutical companies that seek profit at all costs. We don't give much credence to this kind of argument.

My colleague Ms. Lelièvre may want to add a comment.

[Colette Lelièvre, Responsible for Campaigns, Amnistie internationale Canada francophone]

Good afternoon.

The argument suggests that pharmaceutical companies would receive no compensation, but this is not true. Any waiver adopted by the WTO is accompanied by financial compensation. So the companies would still be compensated. As far as we know, there are a number of waivers pending at the WTO, and this has not prevented research and development.

In addition, public funding has been provided for the development of most vaccines. In this sense, one can now ask questions about how these vaccines are used. At least one can ask who can receive them, given the global situation. We are facing an exceptional pandemic, and it requires the implementation of exceptional measures.

The arguments put forward by Mr. Paquette are not helpful from a public health point of view. This is indeed the crux of the matter.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Langlois and Ms. Lelièvre.

Mr. Thériault, you only have 10 seconds left. You can make a brief comment, but you don't have enough time to ask another question.

[Luc Thériault, Bloc, Montcalm, QC]

If you don't mind, I'll save those seconds for later.

[The Chair, Liberal, Sean Casey]

Mr. Davies, please go ahead for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Dr. Warshawsky, I think I had promised to come back to you. What is your position and the position of NACI on using boosters for those who have infection-acquired immunity?

[Dr. Bryna Warshawsky]

NACI does recommend that people who have had infection should be vaccinated.

They have recently come out with some suggestions with regard to the time period between infection and vaccination. They have said if you've had an infection and you haven't yet completed or started your primary series—your first few doses—you should wait eight weeks from that infection to get the first or second dose of your primary series. That's to allow that infection to help mount a good response from the infection, but then to enhance it with a vaccination, because we know that protection from infection can be variable. If you have a mild infection, you may not mount as good an immune response. We know that for protection against omicron, if you've had an omicron infection, you don't mount a very good immune response against other types of COVID-19, against other variants.

It is very important to be vaccinated after you have been infected, but NACI recommends these intervals. They suggest to wait eight weeks for your primary series, and then for your booster, they suggest to wait three months between the infection and your booster or at least six months between your primary series and the booster, whichever is longer.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Kalyan, having heard that, what does the data say to you about boosting people with COVID-acquired immunity?

[Dr. Shirin Kalyan]

There is really no data. That's why the EMA and the WHO have not recommended getting boosters, especially with the original strain of the vaccines, because you're essentially.... It's like recovering from the flu and then you get a vaccine for the previous strain and boosting that response. I don't have any data to suggest this would be a good idea.

What the data shows for people who have had COVID and recovered is that their immunity is pretty reliable.

[Don Davies, NDP, Vancouver Kingsway, BC]

In terms of boosting, we know that the vaccines wane. You have great coverage for a while but they wane. The European regulators have indicated that we can't be boosting ad infinitum and that it may actually eventually be harmful. What is their long-term game plan?

[Dr. Shirin Kalyan]

That's what I was hoping, that we would take a more responsible approach and wait for data. At this time, what they are seeking to do is diversify their portfolio of the types of vaccines available. I know there are a lot in the pipeline still. One of the miracles of the mRNA vaccines was based on the fact that you can just pump them out super fast, and that gave them an advantage so they could be a good filler. But at this point in time, if they were so good at coming up with new vaccines, then you would have thought that they would have already developed a variant-specific one, because right now, omicron is spreading because these vaccines don't show. It's an immune escape variant.

I think requiring more data and seeing whether or not it makes sense to actually vaccinate people who have already had omicron and recovered, and see what the benefit of that is, makes sense to me at this time.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kalyan and Mr. Davies.

Next is Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

On behalf of this committee, I'd like to apologize to Dr. Kalyan for the intrusive nature of my colleague's questioning with respect to asking you to provide individual health information. I apologize for that.

Given that, Dr. Kalyan, maybe you could outline “informed consent” for this committee. I think that perhaps is germane. I know that you spoke a bit about it in your preamble, but maybe you could give us just three or four points around informed consent, if you would, Doctor.

[Dr. Shirin Kalyan]

It's the fundamental piece of any kind of medical intervention that a person understand their own personal risk from the intervention and their own personal risk from the disease in question. I'm not sure if everyone has been given.... Because it's an evolving science, especially around the new platforms, which are very promising, we don't have very good longitudinal data. That's still coming in, so to provide actual informed consent is challenging right now, because people's risks are very disparate for the disease, as well as the adverse effects.

We saw that quickly. We moved quickly with the adenovirus vector vaccines. We saw that VITT, especially in women, became less used in Canada, but we haven't really moved as quickly on the mRNA vaccines for young men, for example, and advising them appropriately.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Kalyan.

I'm going to shift gears a bit to go to Dr. Cohen, if I might.

You talked a tiny bit about increasing vaccine uptake with dialogue and education and also about how health care providers speak to individuals. I'm wondering, Dr. Cohen, if you might comment on the federal government's use of disparaging and dividing language with respect to how that might increase uptake, if you would.

[Dr. Karen R. Cohen]

I think one of the key messages for some of the research that looks into why people are hesitant to get vaccines is that there's not a single reason. Dr. Lavoie's research suggests that there are a few categories of people who resist vaccines. It might be that some folks need more information. For some folks, it's much more practical: They have difficulty leaving work or getting child care to go and get vaccines.

For others, it really might have to do with confidence. The way in which health care providers speak to their patients about their concerns really impacts how they follow up on their advice. I'm sure my medical colleagues here would agree with that. The better someone understands their disease and their treatment options, the better-informed the decision they're going to make.

I think the important take-away of the behavioural science research is that there are many reasons why people may be hesitant to get a vaccine, and what you do about it depends on the reason they have.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Cohen.

Is it safe to say that perhaps calling them names is not that useful?

[Dr. Karen R. Cohen]

Well, for many psychosocial reasons, calling anyone names is not useful.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Cohen. I appreciate that.

I'll go back to Dr. Warshawsky, if I might.

My colleague talked a bit about doses in the future, vaccine durability and how many doses we're going to need. Dr. Warshawsky, could you speak a bit, if you would, about the future of vaccines and what that may look like in terms of variants? How many doses are we talking about? I believe Israel is on dose number five.

[Dr. Bryna Warshawsky]

Thank you very much, Mr. Chair.

At NACI, the National Advisory Committee on Immunization, we monitor the authorized vaccines or the vaccines that we expect to be authorized and make recommendations with regard to those vaccines. We're currently looking at the current vaccines and how we can best make use of them.

As new technologies become available—if we get future technologies that may, for instance, look at mucosal vaccination or vaccines that enhance other parts of our immune response such as T cell immunity—as those vaccines become authorized in Canada, NACI will look at those vaccines as well and make recommendations with regard to them.

We know that the whole scientific community is watching to see what the next types of vaccines will be. They're watching what the manufacturers will put out with regard to potentially multivalent vaccines—vaccines that cover the wild-type strain and the omicron strain—and whether those may be more beneficial for future boosting. As those become authorized or the manufacturers put those forward for authorization, we will then, within the national advisory committee, look at those as well and make recommendations in the context of the epidemiology and the other vaccines available for Canadians.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Doctor. I appreciate that.

Madame Langlois, I'm not sure if this is within your ability to answer, but can you comment a bit on Canada's contribution to the COVAX program and on how we've done with respect to that?