Health Committee on March 23rd, 2022

[The Chair, Liberal, Sean Casey]

I would ask you to respond briefly, if possible, Ms. Langlois.

[France-Isabelle Langlois]

I will hand over to my colleague Colette Lelièvre.

[Colette Lelièvre]

I don't have the latest figures, but Canada is still considered a country that participates in the COVAX mechanism to a large extent. It has pledged a huge number of doses.

I know there are still challenges with the doses pledged to the mechanism and the timelines for delivery of those doses internationally. I don't know where that stands now, but I know they are significant challenges.

We would like to see more predictable and regular deliveries. We would also like to see Canada use mechanisms like COVAX to distribute vaccines that were over-ordered in Canada, because this allows for equitable distribution among countries that have limited means to purchase vaccine doses for their own populations.

I don't know if that answers your question, but that is what we know at the moment on the issue.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Lelièvre and Dr. Ellis.

Next is Dr. Hanley.

Go ahead, please, for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Thanks to all the panellists.

Dr. Warshawsky, first of all, having been in the game for a while, I want to recognize the incredible work that you and other members of NACI have been performing during the last two years, often under incredible pressure. I wonder if, sort of at a high level and as briefly as possible, you could comment on some of the challenges associated with translating data during a pandemic into policy and vaccine recommendations.

[Dr. Bryna Warshawsky]

Thank you very much for the question.

Definitely one of the challenges has been the paucity of data. At the beginning, we often don't have a lot of data. We have the clinical trials, but they are done in specific populations in relatively small numbers. We have to make our best recommendations with the available information, and then continue to monitor the ongoing information that comes from real-world use—effectiveness trials and safety trials in the real world. Then we incorporate that back into our recommendations and revise them if needed.

It has been an ongoing iterative process of trying to make the best recommendations with the available information and then staying on top of all the evolving information and modifying as needed.

[Brendan Hanley, Liberal, Yukon, YT]

I must say that I think you've been very nimble in doing that.

Could you also summarize, according to your understanding, the current state of understanding of natural immunity versus vaccine immunity with regard to the omicron variant?

[Dr. Bryna Warshawsky]

Yes. Thank you for the question.

If you've had omicron as your only infection, you mount a response against omicron, but it doesn't provide a very broad response against other types of variants—past ones for sure. We don't know what the future will look like. However, if you have vaccine-induced immunity and infection on top of that, in whatever order—and in fact, they say if you've had three exposures to either vaccine or a combination of vaccines and infection—that gives you the most solid protection. So it seems to be the three exposures to the SARS virus or vaccine that give you really good, solid protection.

Relying on infection alone, there's variability. It may not last, and it may not be very broad. You really get this solid protection when you have either three doses of vaccine or a combination of vaccine and infection.

[Brendan Hanley, Liberal, Yukon, YT]

That certainly speaks to the complexity behind this and to how easily one can be misled by sweeping statements on natural immunity versus vaccine immunity.

I wonder if you could talk briefly about the additional value of recent vaccine products, particularly the virus-like particle vaccines and what potential they will offer in months and years to come in terms of broadening our array of vaccines.

[Dr. Bryna Warshawsky]

Thank you very much for the question.

As you know, two new vaccines have been authorized recently. One is a protein subunit vaccine, which is the Novavax vaccine. The other is a virus-like particle vaccine, which is the Medicago vaccine. Medicago's is a new technology based on growing the vaccine in plants, so that's a very interesting new technology.

NACI has made recommendations with regard to both of those vaccines. It has expressed a preference for the mRNA vaccines, which we have been using for a long time. We have a lot of comfort with regard to their effectiveness and their safety. While data accumulates for the other vaccines, we have certainly said that if someone doesn't want an mRNA vaccine, then the Novavax and the Medicago vaccines are options that they can take. We have a lot more experience with the mRNA vaccines right now, so the preference is for those vaccines.

As mentioned before, we'll get more information about these newer vaccines and NACI will adjust its recommendations as needed.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much, Dr. Jacobs, for your really interesting presentation. There's a lot I could ask.

Perhaps the most useful question might be how you as a hospital are looking at what you've learned to prepare for what might be the next threat, whether that's another variant or another virus. How are you, as a hospital, using this experience to incorporate the ability to see patients?

[The Chair, Liberal, Sean Casey]

Give a short response, please, Dr. Jacobs.

[Dr. David Jacobs]

We must preserve our capacity to treat all patients. We must increase our capacity to treat patients who are sick from severe viral illnesses. That, basically, has to impact how we think about the virus and our ability to adjust our risk tolerance. It also mostly has to do with manpower issues.

Going through it very briefly, we are desperately short on ICU nurses. We need to have some sort of program whereby we can have nurses who are able to slip into the ICU as necessary. That's very difficult, because it's highly specialized care. The alternative is to have an overabundance of ICU nurses, which is a very expensive proposition. We have to choose, though. We can't not have one or the other.

With regard to keeping our capacity, we have to recognize that low-risk procedures have to continue throughout the pandemic. We can either do those in facilities outside of the hospital, or we can recognize that the risk is quite low and just soldier on, knowing that there will be some patients who are exposed to whatever virus comes next or whatever wave comes next. We can't just stop cold anymore.

This is a very complex issue. I'm not sure that we're going to have time to dive into that right now.

[The Chair, Liberal, Sean Casey]

Maybe someone else will lead you to continue the discussion. Thank you, Dr. Jacobs.

Next we're going to go to Mr. Lake, please, for five minutes.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you, Mr. Chair.

I'm going to dive into something that's complicated. I have to try to get my own head around the way I frame it.

When we're talking about the evidence base around vaccine mandates, oftentimes we're having debates here in the House about mandates, but not so much the evidence base around vaccines. I think there's a fairly widespread—maybe not unanimous, but very widespread—agreement among 338 members of Parliament around the evidence on vaccines.

My question is for Dr. Warshawsky. Does NACI advise the government on evidence around vaccine mandates particularly, or is the decision to mandate vaccinations more of a policy decision based on the evidence around vaccines?

[Dr. Bryna Warshawsky]

Thank you for the question.

NACI does not make recommendations with regard to mandates. NACI gives expert advice with regard to the use of vaccines—which products and which populations—but mandates are a federal, provincial or territorial decision.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

The decision to mandate, though, would be more of a political decision, based on the advice you give around the efficacy of vaccines.

[Dr. Bryna Warshawsky]

That's right. NACI would provide information on how well vaccines work and what their recommendations are for vaccines, but they wouldn't provide information or advice on whether to mandate or not. That would be within the realm of the provincial, territorial and federal policy-makers.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Okay.

My next question is around the most effective arguments to convince Canadians to get vaccinated. This can be for anybody on there. What, in your view—and maybe this goes more directly to the doctors on the panel today—would be the most effective arguments to convince Canadians to get vaccinated, that is, folks who, for whatever reason, haven't at this point in time?

Maybe, Dr. Jacobs, you could start, because you've spoken to it a little bit and it sounds like you're very adamant that it's important for people to get vaccinated. What would be the most effective arguments to convince those who aren't?

[Dr. David Jacobs]

At this point, many of the people who are not vaccinated are in small groups, smaller communities, and I think that if we're really going to get those people to get vaccinated, we have to reach out to them with very specific programs. Whether it be a religious group or a cultural group, you have to get in there and give them the information they need to make an informed decision. It's a ground game at this point.

Earlier on, we were always a little handicapped by patient privacy. If I could have shown people what I saw on imaging, if I could have talked to people directly about cases, I have no doubt in my mind that many people would have run out the next day and gotten vaccinated. I saw things that I have never seen in my career—and I've been doing this for a couple of decades now. I saw people on ventilators with torn-out lungs. That's not something that you see normally.

This has been an incredibly serious illness, but because of patient confidentiality, because of patient privacy, we're not able to speak freely about the impact on patients. I wonder whether, if we had had some way of getting around that, we would have been able to better share the seriousness of the illness. But it's always a balance.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

So it's fair to say that if Canadians better understood the health impact, they would make better decisions.

Does anyone have any evidence that the argument that most people who have chosen not to be vaccinated are misogynists or racists...? Is there any evidence that points to the fact that many Canadians who aren't vaccinated are, to quote the Prime Minister, misogynists and racists? Is there any evidence that points in that direction?

The second part of that question would be, is there any evidence that making that argument convinces people who haven't chosen to get vaccinated already to get vaccinated?

[Dr. David Jacobs]

It was a uniquely unhelpful thing that the Prime Minister did when he said that. It was politically driven. It did not help anyone in the health care industry. It did not convince anyone to change their mind.

The people who remain unvaccinated right now are very much a mixed bag of people. Some of them are unvaccinated because they have looked at the research and they disagree with the findings the majority of health care workers and scientists have come to in terms of conclusions. There are other people who are just simply afraid. There are other people who have been misinformed by social media. It's quite a wide array of people, and name-calling is not helpful.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Jacobs and Mr. Lake.

Next is Mr. Jowhari, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to all of our witnesses for joining us today and for their comments.

I'd like to take the conversation in a bit of a different direction. I'd like to talk about a potential pandemic that is not virus-based and we may not have a vaccine for it to be able to debate on. I'd like to talk about mental health.

Ms. Eaton, welcome to our committee. In your opening remarks, you talked about the fact that 64% of the people in Canada are worried about new variants. I actually had an opportunity to read the survey that was put out by the CMHA. My compliments, it was a great job. In that survey, the findings also pointed to some other types of threats or concerns, such as climate change and concerns people had about their employment.

Can you shed some light on these findings and share with us some of the percentages or some of the data you found?

[Margaret Eaton]

Thank you so much.

When we looked at sources of stress, we saw that 30% of Canadians were feeling worried about money, even though this was later—the findings were taken just before omicron. They were also very worried about the mental health of their children—21% mentioned children. Sixteen per cent of people were worried about having enough food. When we looked at those vulnerable populations in particular, we also saw suicidal ideation was up.

In a normal year, 2.5% of Canadians have suicidal thoughts. The average number across the last two years was 8% to 10% of Canadians having suicidal thoughts. If we looked at those vulnerable groups that I mentioned—indigenous people, LGBTQ—we saw that number go above 10%.

People are really struggling through this time.