Health Committee on May 2nd, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 19 of the House of Commons Standing Committee on Health.

Today, we will meet for two hours to hear from witnesses on our study of the emergency situation facing Canadians in light of the COVID-19 pandemic. Before I introduce today's witnesses, I have a few regular reminders for hybrid meetings.

Today's meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021. As per the directive of the Board of Internal Economy of March 10, 2022, all those attending the meeting in person must wear a mask, except for members who are at their place during proceedings.

I know that most, if not all, of our witnesses have been here before. You would know very well some of the standard directives.

Please wait until I recognize you by name before speaking. All of our witnesses are appearing by video conference. Click on the microphone icon to activate your mike, and mute yourself when you're not speaking. Translation is available. At the bottom of your screen, you have the choice of floor, English or French. As a reminder, please refrain from taking screenshots or photos of your screen. All proceedings today will, of course, be made available via the House of Commons website.

To the committee members, in accordance with our routine motion, I am informing you that all witnesses have completed the required connection tests in advance of the meeting.

I would now like to welcome our witnesses from the Public Health Agency of Canada who are with us this afternoon. They are Dr. Harpreet Kochhar, president; Dr. Theresa Tam, chief public health officer; Dr. Howard Njoo, deputy chief public health officer and interim vice-president, infectious diseases programs branch; Cindy Evans, vice-president, emergency management branch; Stephen Bent, acting vice-president, COVID-19 vaccine rollout task force; and Jennifer Lutfallah, vice-president, health security and regional operations branch.

Thank you all for your service. Thank you all for your presence.

Dr. Kochhar, I understand that you will be making the opening statement. If my understanding is correct, you have the floor for the next five minutes.

Welcome to the committee.

[Dr. Harpreet S. Kochhar, President, Public Health Agency of Canada]

Thank you, Mr. Chair.

Thank you for inviting Public Health Agency of Canada officials to provide an update on the COVID-19 pandemic.

We are pleased to be here. Joining me today are Dr. Theresa Tam, chief public health officer; and Dr. Howard Njoo, deputy chief public health officer. Also accompanying me are Ms. Cindy Evans, vice-president of emergency management; Stephen Bent, acting vice-president, vaccine rollout task force; and Ms. Jennifer Lutfallah, vice-president, health security and regional operations.

Since we last provided you with an update, there have been significant changes across the country. However one thing has stayed the same. COVID-19 is still circulating widely. Disease activity remains high in Canada, and the BA.2 sublineage now accounts for more than 90% of sequence variants. However, there are early signs that transmission may be nearing a peak in some jurisdictions.

We expect further ups and downs over the coming months, but maintaining a vaccines-plus approach can provide us with better protection going forward. This means continuing to take personal precautions like masking, improving ventilation and staying home when we have symptoms or test positive. It also means maintaining a strong core of protection against severe illness by getting up to date with COVID-19 vaccines, including booster doses. It is a crucial time to ensure that we and our loved ones are up to date on routine vaccination and catch up on any that have been missed or delayed over the pandemic. Vaccinations help keep us healthy from childhood through adolescence and into adulthood.

As of January 2022, over 74 million total doses of COVID-19 vaccines have been administered in Canada. I'm pleased that the number now stands at more than 83 million. Nationally, more than 89% of eligible Canadians, those five years of age and older, have at least one dose of a COVID-19 vaccine. Approximately 81% of the population has received two doses, and as of April 29, more than 18 million Canadians have received a booster dose.

At this time, the national advisory committee on immunization strongly recommends a first booster dose for adults aged 18 years or older, and adolescents from 12 years to 17 years of age who are at high risk of severe outcome or exposure.

In addition, NACI recommends that a first booster dose may be offered to anyone aged 12 years or older in the context of heightened epidemiological risk. NACI is also recommending that a second booster dose be rapidly deployed and prioritized for those who are expected to benefit the most, namely the residents of long-term care homes and other congregate living settings for seniors, and seniors 80 years of age or older living in the community. At this time, Canada has a sufficient supply of mRNA booster doses for all eligible Canadians.

Internationally, the outlook for COVID-19 has shifted. So too has our approach at our borders. When I last appeared, everyone coming to Canada had to be tested for COVID-19 prior to arriving at the border. However, on February 28, we expanded the options for the pre-entry test requirements, and then on April 1, we removed this requirement for fully vaccinated travellers. As of April 25, we removed the pre-entry testing requirements for unvaccinated or partially vaccinated children aged five to 11 who are accompanied by a fully vaccinated parent, step-parent, grandparent, guardian or tutor. Pre-entry tests are however still required for partially vaccinated or unvaccinated travellers aged 12 or older.

We continue to monitor our borders and assess risk, and our measures remain flexible and adaptable so that we are prepared for future scenarios.

We are at a turning point in the pandemic. We are transitioning to sustainable management. Progress may not be linear and, at the same time, we are preparing for future waves and a possible worst‑case scenario.

I encourage everyone to keep their COVID‑19 vaccines up‑to‑date, including getting a booster.

Be aware of the risks in your community and maintain individual protective practices, such as wearing a mask and staying home when sick.

Together, these measures will help protect us as we move forward.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Kochhar.

We're now going to begin rounds of questions, starting with the Conservatives with Mr. Barrett, please, for six minutes.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks very much, Chair.

Thanks to everyone from the Public Health Agency of Canada who is here today.

Thank you, Dr. Kochhar, for your opening remarks. You spoke about the change to entry requirements that was enacted recently. I'm wondering if there is any documentation, perhaps a decision tree or established benchmarks that were used to arrive at that decision, that is being used to monitor with respect to making future decisions.

Dr. Kochhar, if such documents exist, would you be able to table them with the committee?

[Dr. Harpreet S. Kochhar]

We have continued to monitor the epidemiology, the vaccination rate in Canada and the available tools we have with us—for example, the availability of therapeutics like Paxlovid—and these are all taken into consideration as we relax our border measures. Those are the components that we take into consideration while we change our border posture.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thank you doctor for that response. I'll just leave it open-ended, sir. Following your appearance today, if you or your staff find that there are documents that you believe would be helpful in informing the committee and Canadians with respect to that decision-making process and that may get into a bit more granular detail, I'd very much invite you to submit those to the committee.

Testing requirements for incoming international travel remain in place more than two years into the pandemic. This has created pretty serious bottlenecks at Canada's largest airports, including significant aircraft holds at the gate and delays offloading passengers. This worsens Canada's ability to attract tourists, which has downstream impacts on trade and investment relationships with other countries, our allies and partners.

What is the Public Health Agency of Canada doing to update or remove legacy processes at the border, including international arrival testing, to ensure that these backlogs do not occur during the peak summer tourist season and beyond? We're certainly seeing those backlogs right now.

[Dr. Harpreet S. Kochhar]

Mr. Chair, I invite my colleague Jennifer Lutfallah to respond, as she has been managing the border operations.

[Jennifer Lutfallah, Vice President, Health Security and Regional Operations Branch, Public Health Agency of Canada]

We are aware of the gate holds that have been occurring across the country. There are a number of factors that are contributing to those gate holds. In terms of your question with respect to testing, as you are aware, we have moved over to an MRT system, which has significantly decreased the number of individuals who are being tested at airports, thereby reducing the number of people within those airports. Unvaccinated individuals, as you know, continue to be tested via our border testing program.

As I understand it, there continue to be issues with respect to individuals who have not completed ArriveCAN, which has led to individuals being referred over to PHAC, thereby creating bottlenecks, if you will, within the airport.

We are working with our federal partners, as well as airport authorities and airlines, to ensure that those individuals in fact complete their ArriveCAN prior to boarding the flight, thereby reducing the volume of individuals within those airports. We're hoping that these measures, as well as others that we continue to assess with CBSA as well as Transport Canada, will get us ready for the summer period.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

I thank you, Chair, and I thank the witness for the response.

In addition to slowing down people's arrivals, we've also seen the emergence of evidence that this type of arrival testing is not effective. I'm seeing that there are few countries that are actually continuing to employ arrival testing. I'll ask two question because I only have a minute and a half left.

Why is PHAC continuing to pursue this particular method? Controls are important, but why are we continuing with this one at Canada's biggest airports? Second, wastewater testing is a better early warning tool than arrival testing, so I'm wondering if PHAC is undertaking steps to expand the use of wastewater surveillance.

[Dr. Harpreet S. Kochhar]

Let me start by mentioning that the post-arrival testing is actually a very important tool for us to monitor the prevalence of COVID-19 in fully vaccinated travellers arriving, specifically to monitor new variants that might be of concern because that is how we track them, and we can take action. Also, we identify travellers for whom compliance and enforcement activities are required, so if they're not actually vaccinated, they are directed to a DQF, or they are directed to do day 1 and day 8 tests. That is an important piece for us and our programming.

Wastewater testing is a tool that we have been using in the cities, where we are using a lot of stuff. Major cities have been able to test the wastewater and give us an early warning signal about what is circulating in those communities. Accordingly, the individual choices as well as the community availability of the tools can be upped, such as making sure there is masking, for example, or making sure individuals take particular precautions around going into a cumulative setting. Wastewater continues to be a part of our tool kit as we move forward.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kochhar and Mr. Barrett.

Next, we're going to hear from Ms. Sidhu for six minutes, please.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here with us.

My first question is to Dr. Tam.

Dr. Tam, this pandemic has had significant impacts on mental health across the population. If we look at seniors, they are socially isolated, and youth are also impacted. How can we better address the mental health of Canadians, especially for certain vulnerable populations?

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Mr. Chair, I thank the member for her question.

This is an extremely important question because mental health is of course very important. The overall health of the population—even before the pandemic—is something we have to address in a more concerted manner, but the pandemic has had a really significant impact on mental health across numerous populations, not just because people are worried about the virus. It's compounded by the impact of the disruptions to our lives, our work routines, financial stress, social isolation, grief and bereavement because of the loss of loved ones, and reduced access to available services and supports.

These impacts have been particularly acute for certain groups, including frontline health workers, who've experienced worsening mental health conditions during the pandemic, racialized Canadians and others who have been impacted by the social determinants of health and inequitable access to services. I think this is a big issue, as is the concurrent, parallel and worsening opioid and other substance use overdose crisis.

The response to this has to be multi-faceted. By the way, we have had some innovation and new approaches that I believe will benefit mental health during the pandemic and in times to come, for example, the Wellness Together platform and PocketWell have allowed numerous Canadians, including youth, to have access to more real-time services through so-called “stepped care”, as part of a range of measures. I believe budget 2021 provided funding, $10 million over three years, for the Public Health Agency to support projects that would promote mental health, especially those most impacted by the pandemic.

As I said, because health workers and frontline essential service providers have been severely impacted by PTSD—that's post-traumatic stress disorder—and trauma, there was $50 million provided over two years, starting in 2021. These projects are beginning in the spring, I hope. It is spring now, so we want to be able to look at how this diverse programming can support our frontline workers who have been burnt out and impacted.

Of course, there has been a significant investment in Kids Help Phone. The capacity of distress centres has been augmented, and additional funding has been provided to the Canada suicide prevention service.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Dr. Tam. The next question is about vaccination.

Data still shows that there are gaps in coverage for COVID-19 vaccination. Recently, the Minister of Health came to Peel to visit the medical officer of health, Dr. Lawrence Loh, and we had a conversation about how to continue encouraging Canadians to get vaccinated.

How do you think we can continue to encourage Canadians to get vaccinated against COVID-19?

[Dr. Theresa Tam]

Thank you for that question.

I think that vaccines remain a cornerstone of our ongoing management of COVID-19, and it is really important to continue to encourage uptake of the first two doses but also the boosters now for up-to-date vaccination.

I think there are a number of reasons why, for example, the booster rates are not as high as for the first two doses, and we need to understand better and address those issues. I'm sure that when you're on the ground in Peel, some of the local health units will talk about the different challenges experienced by different population groups.

There's certainly a lack of trust in policy-makers, public health officials and governments by certain groups that have been experiencing inequities. There's complacency, people thinking that two doses is enough, when we know that, with the arrival of the omicron variant, you need to get up to date with the booster dose when eligible. Convenience and access is still an issue for many, so local public health has been using many different measures to try to improve access through mobile clinics or getting pharmacists.... Thank you, pharmacists, for providing your support to getting vaccines into arms.

I think a lot of different information and misinformation also doesn't help. Providing credible information through health care providers is a really important component and one that the public health agency has been supporting by providing health care providers with credible information so that they can counsel their clients.

Because of the trust issue, we've been trying to enable local leaders in their communities, including faith leaders and other trusted leadership, in order to augment trust and vaccine uptake. I think you need a multi-faceted approach, as we had for the first two doses.

I remind you that if you recently had COVID, you can get a vaccine as recommended, but you wait three months before you get a booster. Omicron virus itself may not provide consistent protection against further infection, so it's also important to trust that point.

For parents, I think that the uptake in children aged five to 11 could be better. I just want to reassure parents that over three million doses have been provided to kids in Canada, and there are no safety signals. Many children have been vaccinated around the world, so we encourage parents to seek answers to their questions and get their kids vaccinated.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam and Ms. Sidhu.

Now it's Mr. Garon's turn.

Go ahead, Mr. Garon.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you very much, Mr. Chair.

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

Dr. Tam, in terms of people's reaction to vaccines, the situation has really changed. There seems to be much more confusion than before. People think that each booster will be the last. They thought the first booster would be enough, and they are often surprised that they need a third and a fourth. Today—

[The Chair, Liberal, Sean Casey]

Mr. Garon, I'm sorry for interrupting you.

Colleagues, the bells are ringing. We're obligated to suspend the meeting unless there is unanimous consent to proceed for a period on which we all agree. What's the pleasure of the meeting?

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Chair, I would say that we would consent to complete the first round of questions.

[The Chair, Liberal, Sean Casey]

Okay, so that would be Mr. Garon and Mr. Davies.

Is that acceptable? Is everyone okay to continue until Don's finished his turn?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

Thank you.

You can start over, Mr. Garon.

[Jean-Denis Garon, Bloc, Mirabel, QC]

When you talk to people, consult the media and observe people's attitudes toward vaccination, you realize that people are increasingly confused. They thought that one booster would be enough and are surprised they need a third and a fourth.

Today, we're witnessing a decline in confidence among Quebeckers and Canadians, and everyone is developing their own theory about the duration and effectiveness of vaccines, among other things.

What could be done to improve scientific communication? What is currently being done?

Wouldn't it be appropriate, for example, to tell Canadians and Quebeckers in advance how often they'll have to get a booster?

What work is the Public Health Agency of Canada doing about this type of communication?

[Dr. Theresa Tam]

Mr. Chair, maybe I will take this question.

That's a very important question. Of course, we are learning about both the virus and the vaccines over time. The duration of the protection of the vaccine, which we saw as extremely good with two doses of vaccine at the start, really shifted when the omicron variant appeared. There are changes in the virus itself.

It's really important to provide Canadians with up-to-date information as we have it. Both Health Canada, in its authorization of vaccines including boosters, and the national advisory committee on immunization will address the recommendations with the increase in knowledge.

I think that's what we've been seeing happen over time, and I think Canadians really rolled up their sleeves and got the first two doses. I think there's an increase in understanding that boosters are important, all the chief medical officers and the national advisory committee on immunization came out again strongly, given the evolving evidence, to say, “If you're 18 and over, go get boosted. Even if you've been infected, wait three months and go get boosted.” That is a much clearer message, I think, than when we were still trying to learn about the impact of omicron and the booster doses.

I think that's a very clear message and I hope all Canadians will get boosted, but we will keep learning as we go along. We're preparing for any potential re-emergence of different variants, and we have to check the effectiveness of the vaccines against those as they emerge. We cannot know that ahead of time. We also have to prepare ahead of time for a potential for a fall-winter respiratory season during which, Canadians should bear in mind, governments will likely come out to recommend additional doses as well.

I think the most important thing is to keep the communication channels open and, as I said, capacitate health care providers and other trusted leaders in providing the credible information.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you very much, Dr. Tam.

Let's talk about another aspect of the situation. We see summer coming, we see tourism starting up again, we see the flow of travellers starting to increase again. This is very good. We're happy for our regions and for our economy. However, we know that all the health restrictions, which are obviously a provincial responsibility, have sometimes eroded social cohesion, so we're a little more reluctant to impose new restrictions.

What are your projections on the trajectory of the pandemic? I know you don't have a crystal ball, but I'd like to know how you see the summer and fall months ahead.