Health Committee on May 2nd, 2022

[Dr. Theresa Tam]

I think that at the moment we, together with the other chief medical officers, have been characterizing this period as a transition period. We hope we're passed the extreme acute phase, the crisis phase of the pandemic, but we're on the road to a more steady state. We're not there yet, so there's unpredictability in the timing of the waves and what variants might come along.

There may be a seasonality to this virus, in that it will go up and down like influenza, but we don't know. We have to keep our surveillance and our information channels, as I said, going throughout this fall and winter season, and we'll evaluate at the other end.

However, the good news is that with the high vaccine coverage as a whole—we need the boosters, of course—there's a high level of immunity. You may have seen some of the results post-omicron wave, which mean that globally and domestically there is an increase in the population level of immunity. That is good in terms of the chances of our being able to keep society open.

Going forward, what is important is preparedness. Get prepared. Get prepared for a potential nasty variant that's going to come along and is not only highly transmissible but can cause a severe outcome. Be prepared for that scenario. I think we now stand a better chance of gaining some of that normality back.

I would say that Canadians who have learned all these different great public health measures, personal protective measures, should consider keeping going with those layers of protective measures that they can put on, not just for COVID-19 but for influenza and other respiratory viruses that are making a comeback. It's a matter of developing these personal habits to try to reduce the need for the escalation of more restrictive public health measures.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next is Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the guests for being here.

Dr. Tam, on April 12, a little over two weeks ago, you said the following:

It depends on the location, but yes, we can say we are experiencing a sixth wave in Canada, generally speaking.... There has been a rise in COVID-19 activity everywhere.

Dr. Tam, have we reached the endemic phase of COVID-19, in your view?

[Dr. Theresa Tam]

In my view, no. As I just said in my last response, we are in a transition phase. An endemic period is where we have much more predictability in the pattern of this virus and can then anticipate a more regularized response, if you like. We're not there yet, so we have to be careful.

Yes, we are still experiencing that BA.2 sixth wave.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Dr. Tam.

In your view, is it premature to lift federal mask mandates at present?

[Dr. Theresa Tam]

That is not my decision to make. I would encourage everybody, whether there is a mandate or not, to continue to wear a mask in indoor public settings when you're not with people who are in your household.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I may, you're Canada's chief public health officer. If you don't know, I don't know who else to ask, so I'm going to ask you again.

Is it premature to lift federal mask mandates or not? Answer yes, no or you don't know.

[Dr. Theresa Tam]

At the height of a sixth wave, no, I don't think we should be lifting mask recommendations or mandates.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Doctor.

Dr. Tam, PHAC's most recent epidemiology and modelling update released on April 1, a month ago, outlined both the realistic scenario for the future, defined by ongoing transmission with intermittent waves, as well as a worst-case scenario, defined by the emergence of an immune-evasive and severe virus of concern, which I think you've mentioned.

In your view, Dr. Tam, what is the likelihood of the worst-case scenario coming to fruition?

[Dr. Theresa Tam]

That's unpredictable, because in that scenario, you can potentially have a virus that goes somewhat under the radar, maybe developing in an immunocompromised host—

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Tam, let me clarify my question. I know it's unpredictable, but I'm wondering....

This is your modelling. Has PHAC put a number on it or quantified it in some sense, or do you have no idea whatsoever?

I'm just trying to find out if PHAC has put some sort of projection on whatever the likelihood of that might be.

[Dr. Theresa Tam]

I don't think we know the probability, and that's not modelling. It's scenario planning, to clarify that particular presentation. You have to account for both of those scenarios. We don't really know, but I think it definitely could happen, and we need to plan for it.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Earlier this month, Health Canada confirmed that almost 1.5 million doses of COVID-19 vaccines held in our national inventory have expired since January. We had a problem with expired personal protective equipment early on in this pandemic.

Given that Canada has only donated 14.2 million surplus vaccine doses of the 50 million it promised to deliver to the COVAX facility by the end of this year, why were these doses allowed to expire?

[Stephen Bent, Acting Vice-President, COVID-19 Vaccine Rollout Task Force, Public Health Agency of Canada]

Mr. Chair, I would suggest that I take that question.

PHAC works very closely with provinces and territories to ensure that procurement and allocation strategies align with the requirements and demands of individual jurisdictions. When there are doses surplus to Canada's need, Canada makes every effort to make them available to countries through COVAX with sufficient shelf life.

Canada has committed to donating the equivalent of 200 million doses to the COVAX facility by the end of 2022. While the priority will be to place doses to be donated through COVAX, Canada also works for all other potential avenues, including through multilateral and, if necessary, bilateral donations to ensure that vaccines can get to those who need them most.

We are also working with the COVAX facility—

[Don Davies, NDP, Vancouver Kingsway, BC]

With respect, Mr. Bent, I have limited time. If you're not going to answer my question, I would rather you just say so.

The question I asked was why the 1.5 million doses were allowed to expire, not what arrangement you have with the provinces or COVAX.

[Stephen Bent]

We work very closely with Global Affairs Canada and international bodies like COVAX to make doses available as soon as we can, so that they can be used if needed by other countries. We have made doses available to COVAX, and they are in the process of identifying countries that can take them. If no suitable country is identified, the doses are retained by us until they expire.

[Don Davies, NDP, Vancouver Kingsway, BC]

Are you saying, sir, that no suitable country was identified to Canada, so we chose to let 1.5 million vaccine doses expire because we couldn't identify any country that needed them? Is that what your answer is?

[Stephen Bent]

I would offer that we continue to work with COVAX to identify potential countries that could take the doses, and offer as much lead time as possible.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Kochhar, you talked about being up to date, and you gave an example of the flu vaccine. I'm curious about the efficacy of a third or even a fourth booster. Help me understand this, and forgive my ignorance if I don't understand this correctly.

The mRNA vaccines were developed to respond to the spike protein on the first version of COVID-19, which was the alpha version. We have immune escape variants, which by definition are mutating away from that. We've gone through beta, delta, gamma, omicron, and there are others.

Can you help me understand how giving a booster, which boosts antibodies to recognize the original spike protein of the alpha variant, can help produce effective immunity to a virus that has significantly changed since that time?

[The Chair, Liberal, Sean Casey]

Dr. Tam, Mr. Davies is out of time, but could you provide a concise response? If it requires something longer, maybe respond in writing, but go ahead with a couple of brief comments, please.

[Dr. Theresa Tam]

Yes, I'll take that question.

Despite the change in the spike protein through different variants, up until omicron, two doses of vaccine retained really good vaccine effectiveness against the most prominent ones, even though we were monitoring for waning immunity. When omicron arrived, even though it looked significantly different from the delta and preceding variants, through our vaccine effectiveness estimates, a boost provided at least an initial protection of 60%, as a range, against infection and symptomatic disease, and over 90% vaccine effectiveness against severe disease with the third dose. That could wane over time, but that's still good news.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

The meeting is suspended. We'll see you after votes.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order.

Thank you, everyone, and thanks to our witnesses for your patience.

We're going to continue on until probably six o'clock, unless there's a motion to adjourn that is accepted by the committee.

We have about 45 minutes, and we're going to recommence questioning. The next person to pose questions is Dr. Ellis for the Conservatives, for the next five minutes.

You have the floor, Dr. Ellis.

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

Thank you, Mr. Chair.

Thank you to the witnesses for your patience with the shenanigans of government—unfortunately.

That being said, I'll get right to the matter.

Dr. Tam, through the chair, I'm wondering. With respect to some of the questions that were asked previously, would it be in the interest of PHAC...? Would you submit a decision tree on who would make decisions in the Public Health Agency of Canada? We've had some difficulty understanding who makes the decisions. If you would submit that in a simple form, that would be excellent.

Secondly, would it be fair to say that it's the Prime Minister who makes the final decision with respect to federal mandates? It's a simple yes or no, ma'am.

[Dr. Theresa Tam]

That would be a cabinet decision.