Health Committee on March 23rd, 2022

[Dr. Shirin Kalyan]

Yes. Thank you very much.

The clinical trials that were done never really assessed the ability of the vaccines to prevent transmission. I haven't come across a component vaccine that is intramuscularly injected that can be very effective in preventing transmission of respiratory viruses long-term, so I think that understanding and having vaccine literacy is really helpful for the population.

If we had an intranasal live attenuated vaccine, which would be a better type of vaccine, especially for young, healthy kids, for that more comprehensive trained innate immunity and launching an appropriate type of immune response to a certain type of bug, that would probably be a better approach to take.

We didn't understand, I think, when the mandates were put in, because we didn't have a lot of.... The vaccines we're using, we actually have very little clinical experience with. We have never used them outside of emergency use authorization. I think that was the surprise for me as an immunologist. We started mandating the use of these vaccines without having clear data. The companies themselves are just starting to release the anonymized patient-level data. They wanted to not release that for the next 75 years, but we're starting to get more of that clarity on the type of efficacy that the vaccines really have in a placebo-controlled trial.

I would of course want to look at the risk-benefit, and that's where the risk stratification would have been really helpful to identify. We know that, by May 2020, when we didn't have vaccines, 95% of COVID-related mortality was in those over 65 years of age. I think that if we had focused on protecting the most vulnerable, it would have gone farther than putting blanket mandates on everyone, because that actually has the potential to increase vaccine hesitancy...and trust in vaccines and the public health care system in general in terms of recommendations.

I do believe that we should be focusing on providing immune protection and being transparent and looking at the evidence when we have an immune escape variant like omicron. How much data do we have that giving multiple boosters is going to be helpful or is good for people? We really need to diversify.

The first time I spoke to the committee members was back in June. I had really strongly suggested that we diversify the portfolio of the type of vaccines we have available for Canadians. We put all our eggs in one type of basket. We're still in a similar position. With omicron, it's a far less severe type of infection. I understand that people who are frail and who don't have good immunity require some more protection—

[The Chair, Liberal, Sean Casey]

Thank you.

Next is Dr. Powlowski, please, for six minutes.

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

I wanted to question Dr. Kalyan, too.

I wasn't sure on your testimony, where you seem to question the mandates. Admittedly, the vaccines aren't good at preventing the spread of omicron, but you acknowledge that the reason for the mandates was kind of shifted to preventing hospitalization, ICU admission and deaths.

Do you not agree that this is a valid concern and that the government ought to be taking actions to try to prevent hospitalization, ICU admissions and death? As Dr. Jacobs has told us, the fact is that all of that also undermines the ability of the health care system to provide other health services. Am I wrong?

You're giving me the impression that you think we shouldn't have any mandates at all and you don't buy the fact that.... There's tons of evidence about the vaccines decreasing hospitalization and ICU admissions, even with omicron. Kaiser Permanente said that people are 64% to 73% less likely to be hospitalized if they've been vaccinated. From a South African study, it's a 70% reduction in hospitalization for fully vaccinated people. This is omicron. Also, in Quebec, people who hadn't been vaccinated were seven times more likely to be hospitalized and 14 times more likely to end up in ICU.

This seems to me like a pretty good reason to be promoting vaccinations, and social distancing if necessary. Those are pretty significant numbers. Even as of March 14, there were 435 people in ICUs across Canada and 4,200 hospitalized COVID patients.

Maybe I'm misinterpreting you.

[Dr. Shirin Kalyan]

No, you are interpreting the data from non-randomized placebo-controlled trials. I'm not saying vaccines will not prevent hospitalizations, but I don't think coercion is the best way to get people to behave the way you want them to.

I think there are lots of health-promoting activities. If you suggested that people stop smoking, that people exercise, that they reduce their weight.... There are many things that would reduce a hospital surge, but we never really did a more holistic approach to improving people's health, including mental health.

I believe that if people are equipped with the information and understand their own risk profile, it is far more effective than putting a blanket vaccine mandate, especially for people who already have immunity. That's really where I'm coming from. We need better risk stratification.

Canada has never had a policy around which they would mandate vaccines. There is provincial legislation for certain childhood vaccines, but people have the opportunity to opt into that.

I really believe that informing people rather than forcing them to do something is always more effective for health care.

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

I don't know....

Maybe I'll give Dr. Warshawsky from NACI an opportunity perhaps to reply to Dr. Kalyan, unless she does not want to enter into this debate.

[Dr. Bryna Warshawsky]

I can just provide some of the facts that NACI has been looking at with regard to vaccine effectiveness. We do know that for two doses, the vaccine effectiveness against infection decreases over time and it can end up being quite low. With three doses, we do see protection against infection of around 60%. That does decrease as well over time.

With severe disease, we see vaccine effectiveness for two doses at around 65% to 85%. When we add the booster dose, we get protection against severe disease, like hospitalization, in the high 90s. That may decrease over time. That's something we are watching closely.

Thank you.

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

Maybe I can turn my questioning to Madame Langlois from Amnistie internationale.

You mentioned the movement and the ask for the WTO to drop the patent protection on COVID-related items. You mentioned that there was recently a suggestion of a compromise between India, South Africa, the EU and the United States, which you don't support. However, I haven't heard of this compromise. Maybe you could tell us what the compromise was and why you don't support it.

[France-Isabelle Langlois]

What this compromise entails is too great. Indeed, the time frames will be even longer, and the number of countries that could have access to the revenues or technology will be further reduced. This even affects countries that have the potential, such as Kenya and other Asian countries.

In addition, there is a further restriction on lifting patent or intellectual property protection only for vaccines, when there are all sorts of other technologies and products that are and will increasingly be available to treat or prevent COVID‑19. These products are all the more important because they will be effective in reaching the most remote and poorest populations in the world.

It is known that managing the cold chain with regard to vaccine storage is complicated. It is even more complicated to manage in African countries, for example, especially in remote areas in Africa. Therefore, the lifting of patents should cover all products or treatments that are developed by pharmaceutical companies to treat, prevent or cure COVID‑19.

The original proposal was made in October 2020 and it is now March 2022. During this time, we are continually dealing with other waves and losing time. So we need to move forward.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Langlois and Mr. Powlowski.

Mr. Thériault, you now have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I thank all the witnesses for their enlightening testimony.

My first question is for the representatives of Amnistie Internationale Canada francophone.

Ms. Langlois and Ms. Lelièvre, I want to thank you for being with us to present a much more global reflection on the pandemic. I just want to point out in passing that my colleagues Mr. Powlowski, Mr. Davies and I made a public appearance on May 7, 2021, in support of the proposal to lift patents and the proposal that had been made by South Africa.

In the first wave, we were all saying to ourselves that, in order to respond adequately to the pandemic, everyone had to be vaccinated if we were going to make sure that it ended or moved into an endemic phase. We then realized that in the field of research, there were data exchanges. It was quite beautiful to see and there was hope. All of a sudden, vaccines were found, and the beautiful solidarity turned into the stockpiling of vaccines, hoarding, and the less affluent countries were forgotten, so that we go from wave to wave, from variant to variant.

Could you tell us succinctly what the state of the global immunization situation is now, in March 2022?

[France-Isabelle Langlois]

The situation...

[Luc Thériault, Bloc, Montcalm, QC]

Let me ask you my second question right away. You can answer it at the same time. That way, we'll get to the heart of the matter.

Can you explain why you favour the lifting of patents rather than voluntary licensing, as suggested by several countries and the president of the European Commission?

[France-Isabelle Langlois]

The vaccination situation in the world is totally inequitable. In the more affluent countries, the European countries, Australia, Israel, Canada and the United States, the population is overwhelmingly vaccinated because the vaccines are accessible. The unvaccinated are those who are difficult to reach for all sorts of reasons that other witnesses have already mentioned, or they are people who simply do not want to be vaccinated.

In the poorest or lower-middle income countries, the situation is different. According to the latest figures we have obtained, just 4% of the population in these countries in total have had access to vaccines and may be adequately vaccinated. We are talking about two doses of vaccine here.

As I said earlier, even if vaccines were available locally, it would be difficult to vaccinate remote populations in Africa because of the heat. The reluctance that we see here, we see elsewhere. The longer it takes to vaccinate people in low-income countries, the more reluctant they will be to take the vaccine. There is really work to be done on this.

That being said, the more protected we feel here, the more we forget about the rest of the world and the more we forget that we are interconnected. Until there is vaccine equity or access to treatment for all—of course, I'm not just talking about vaccines—the virus will continue to circulate and come back in waves continuously for many years. Let's hope, however, that someday this will end.

That is the status of the vaccine situation around the world.

Could you repeat your second question?

[Luc Thériault, Bloc, Montcalm, QC]

My question was about favouring the lifting of patents over voluntary licensing by laboratories to have their vaccines produced by other laboratories.

Why is the lifting of patents more favourable than voluntary licensing, as the president of the European Commission suggests?

[France-Isabelle Langlois]

We favour the lifting of patents to make the process as fair and transparent as possible for everyone. We want the revenues to be shared so that countries can produce vaccines, where it is possible to do so.

In fact, pharmaceutical companies are resisting the pooling of patents and revenues from drugs and vaccines. So we can't rely on it being done on a voluntary basis.

[Luc Thériault, Bloc, Montcalm, QC]

In terms of the supply chain, doesn't the fact that we can produce vaccines on site facilitate the distribution of vaccines? I am thinking, for example, of the problem related to refrigeration.

[The Chair, Liberal, Sean Casey]

I would ask you to give a short answer, if possible, Ms. Langlois.

[France-Isabelle Langlois]

Indeed, Mr. Thériault, the more vaccines are produced locally, the faster they will be distributed. However, there will still be logistical challenges, particularly for vaccines that require a significant cold chain. For example, in Dakar, Senegal, the distances between regions are great, the roads are complicated, the equipment must be able to keep the vaccines at the right temperature, and so on. All of this presents significant challenges.

So we need to go beyond vaccines. There really needs to be international solidarity in all respects, whether it's logistics, production or technology transfer.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Langlois and Mr. Thériault.

Next we have Mr. Davies for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here.

Dr. Kalyan, you referred in your opening statement and remarks to infection-acquired immunity. How clear is the data regarding its strength and durability, and how does it compare to vaccine-acquired immunity?

[Dr. Shirin Kalyan]

It's actually the gold standard. When we recognize the immunity we get from infection, that's what vaccines are trying to mimic. That's why our biggest successes around eradication have been from live attenuated vaccines, such as the smallpox vaccine, because they most closely mimic that infection.

We know that for COVID, it's been unequivocal that people who have had COVID and recovered are better protected from infection obviously, from serious disease and hospitalization, with the caveat that they survive the first infection. Given COVID particularly, we know the risk factors associated with serious outcomes. There are a vast number of people who have already had COVID-19. I think that with omicron, we'll probably be in a better place as more people get that natural immunity.

[Don Davies, NDP, Vancouver Kingsway, BC]

You've also touched on vaccinating those with infection-acquired immunity. I believe Dr. Tam and NACI—and I'll certainly let NACI have a chance to comment on this—recommend vaccination for people who have infection-acquired immunity.

What is your position on that?

[Dr. Shirin Kalyan]

I don't think they should be subjected to the mandate for this, because their immunity does last longer than vaccine-induced immunity. That has been shown in epidemiological studies, and also recently from the U.S. CDC data from California and New York, which showed that there was no benefit with respect to hospitalization for people who have had infection-acquired immunity getting vaccinated.

I know we've heard a lot about this hybrid super-immunity you get from being vaccinated even if you've had COVID, but that short-term spike in serum antibody levels is not really worth a mandate.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to talk about the issue of waning.

We know that we get a vaccine and it seems to be very effective at preventing hospitalization, serious illness and death for a period of time. I think in your opening statement you said that data from Ontario shows there's a negative vaccine efficacy by the second month in those fully vaccinated, and boosters show similar rapidly waning timelines.

Can you expand on that, particularly what is meant by “negative vaccine efficacy”? How long do the vaccines stay effective?

[Dr. Shirin Kalyan]

With regard to the vaccine efficacy definition, even in Pfizer's, Moderna's and all the vaccine trials, the original definition was for the prevention of infection, not serious disease. From Ontario's data and also the U.K.'s surveillance, they found that people who have two doses, who are fully vaccinated with the mRNA vaccines as well as the viral vector vaccines, after 60 days or so their vaccine efficacy—so you're looking at the number of cases compared to those who are unvaccinated—actually drops below zero. That's been a consistent finding.

It is not so unusual with an immune escape variant. When you're focusing all your immune attention to one particular antigen of a virus, you're obviously going to be selecting for one that is not recognized by the population's immunity against that particular pathogen. That's why I think component-type vaccines are more likely to select for immune variants, as opposed to whole...either live attenuated or perhaps.... Whole vaccines are harder to make.