Health Committee on June 1st, 2022

[Brendan Hanley, Liberal, Yukon, YT]

This is fantastic.

The first is for you, Noni. With your WHO hat on, regarding global vaccines, I just read a headline that the South African company has no market for vaccine production. There's no demand. We know that on vaccine hesitancy, where we're trying to get vaccine to some of the less well-resourced countries, it's probably an even greater challenge than it is here.

Are there any quick comments on that?

[Dr. Noni MacDonald]

I have a couple of quick points that I hope with make this more understandable. It's complex.

One of the problems in South Africa is that over 80% of people have had COVID. They do not see the value of having the vaccine, even though we know that in having had COVID, particularly omicron, you are not protected should we get another variant that looks like delta. Having had COVID, you still need to be immunized with at least one dose, and preferably two. That's number one. They're having trouble doing that.

Number two is that their population demographics are very different from our population demographics. Almost 50% of their population is under the age of 20. They did not see the mortality that we saw, because they don't have those people. I do a lot of work in sub-Saharan Africa in the other thing that I do with an organization called MicroResearch.

I know, from working with those countries, that it's different. Their diseases are different. Their health care system is not a system in many places. The other problem is that when the vaccines arrived, all too often they had very short expiry dates, so they had to give them to anybody who showed up. They were not able to follow the recommendations to give them to the highest risk people, where you were going to see the most benefit.

Because of that, the general public did not see the benefit. We saw that benefit in Canada. We saw how it decreased mortality. But they didn't get to do that.

I can add the other caveat, which is why your question is really important. We do know—and this is not being negative about sub-Saharan Africa—that because they had so much COVID disease going on, mutation was really easy. They had a lot of people who shed virus for a long period of time, because they had untreated, undiagnosed HIV.

In fact, some people said one thing we really need to do in sub-Saharan Africa is increase HIV diagnosis and treatment, so we will have less shedding of the COVID virus and less opportunity for it to mutate. That would benefit all of us.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. MacDonald and Dr. Hanley.

I now give the floor to Mr. Garon for six minutes.

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

Thank you very much, Mr. Chair.

I would like to take this opportunity to thank all the witnesses for their very comprehensive and interesting presentations. I am very grateful to them.

I have a very simple question for Dr. MacDonald. It is perhaps a little naive. I wonder about it very often; I assure you it’s true.

Have we reached the endemic stage of the pandemic in Quebec and Canada? After each wave, we are told that we have. If we haven’t, do we have any criteria to figure it out? Are there objective criteria?

[Dr. Noni MacDonald]

I've been asked this many times and it's not simple.

We would love it if it became endemic, didn't mutate further, and moved to being a “meek and mild” virus. It hasn't quite gotten to meek and mild. We still have people dying from omicron. We still have people being hospitalized with omicron.

If I'm being optimistic, I could hope that, within a year, it will be endemic. It will be a mild to moderate virus that's maybe a bit worse than influenza, with more hospitalizations and deaths than we see with influenza, but not in a huge way. That means not having a big, new variant come along. No one out there can predict that. If a delta variant and an omicron variant come together, it would be wicked. Delta has killed so many more people than omicron has, and omicron is so much more infectious. If you got those two mutations to come together, we'd be in big trouble all over again. I'm sorry to be a pessimist. I want to be an optimist.

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

Dr. MacDonald, if you had taught me, I might have wanted to become a doctor.

Let’s say the virus becomes endemic. The debate about preventive measures, masks and so on, always comes up. We hear one thing and its opposite.

What does becoming endemic imply for the future of these prevention measures?

Supposing that the situation is fine in a year to a year and a half’s time, does that mean that one day we will give up these prevention measures forever?

[Dr. Noni MacDonald]

I want to be a real infectious disease physician, now.

Listen, mask-wearing is not that hard, folks. In a number of countries in the world, even pre-COVID, people were wearing masks all the time. Masks really decrease respiratory viral infection transmission—influenza, parainfluenza, RSV and COVID. If we could get people to wear their masks in the wintertime, we could decrease hospitalizations for influenza, RSV and so on. That would include COVID, as well. I also hope we will give both COVID and influenza vaccines to the designated populations at the highest risk every year, if it's endemic, so we can decrease the thing.

Let me give you one small example that I bet most of you don't know. Do you know that, for stroke prevention...? Because there's a high rate of strokes a week after you get influenza, and a high rate of heart attacks a week after you get influenza, just getting the influenza vaccine is almost as impressive in preventing strokes and heart attacks as taking antihypertensive drugs every day. Think about that.

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

We will certainly think about it. I promise you that.

There are some days I’m not really sure whether decisions about preventive measures, lockdowns, reopening, so on and so forth, are made by public health authorities or by politicians.

Just this week in the House, we were debating a motion where members of the House of Commons, most of whom are not doctors—obviously, that does not apply to some colleagues here—wanted to decide whether or not to lift preventive measures. Some provinces have lifted these measures. The federal government did not lift them all.

Do you think we’ve hit a certain level of confusion because we’ve politicized the issue of preventive measures too much?

[Dr. Noni MacDonald]

That's exactly my point. That's why I'm saying we've never seen politics intrude so much in health policy decision-making as we've seen throughout COVID. Do you know what? Most politicians don't have the science background to sift through that information and make evidence-based decisions. They make decisions they think will make their constituents happy. That's often not the right decision.

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

Dr. MacDonald, I’ve been advised that I have about one minute of speaking time left.

Among young people, there seems to be a new interest in studying vaccines. Some think that vaccines protect us, while others think they don’t. Some people think they protect us against one variant, but not the other. And then some people think they protect us for three months, while others think they protect us for six months or nine months, for example.

If you were to speak directly to young Quebecers and Canadians about the importance of vaccines and their effectiveness, what would you tell them?

[Dr. Noni MacDonald]

We think these vaccines are actually going to last longer than what we had originally anticipated.

We do know that on the fourth doses that have been given to those over 70, it was not to boost them above the level they were at before, but to get them back up to that higher level. The data so far for younger people is that it's working very well provided that you got immunized. It doesn't work so well if you didn't get immunized.

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

Thank you.

I have no further questions, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Thank you to all of the witnesses for your patience.

Dr. MacDonald, the WHO has recently confirmed that there are hundreds of probable cases of severe acute hepatitis in children under investigation worldwide and that these are not caused, it appears, by the usual hepatitis viruses or any other clear source. Is there any reason to suspect that these unexplained cases of severe acute hepatitis in children are linked to COVID-19?

[Dr. Noni MacDonald]

The data I've looked at from WHO would suggest—I'm going to say this so carefully—that it's not due to COVID. Because of the huge numbers of COVID disease even in children, if this were really related to COVID, we should see it.

I want to turn that 90 degrees to say that some people and some researchers are suggesting that this may be co-infection: infection with perhaps an enteric adenovirus. I don't mean the kind that's in the vaccine, but an adenovirus that you would get in your GI tract. It may then get tipped over because of the circumstances, which might be related to COVID and might be related to other infections that are going on.

It's going to take another year, probably, before we're really going to understand it—I'm hopeful that it will be understood before that—but let me give you a parallel. There's a disease called “Kawasaki disease” that we know has to be related in some way to infection. We've been looking for 30 years to find out what it's all about, and we don't know yet.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I want to get your thoughts on infection-acquired immunity.

Let's say that last month I got infected with omicron and I recovered. I'd like you to compare the durability and strength of my “immunity”, if I can use that word, compared with if I had been vaccinated with an mRNA vaccine in a two-shot regime that concluded last January.

[Dr. Noni MacDonald]

Okay. If you had never been immunized and you got omicron, you are not as well protected as if you'd had your two doses of vaccine, because we know that for omicron, when we test it, your antibody response to that doesn't take out delta very well if another delta variant comes along. You're narrow in the spectrum.

People who have had omicron and have not been immunized absolutely need to get at least one and possibly two doses of vaccine to get them up there to be really protected. It's very sad and very bad misinformation that people out there said, “Oh, I've been infected, so I'm protected for life and I don't need to do anything.” That is just wrong.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can I just probe that a bit? The mRNA vaccines that Canadians have been immunized with were formulated against the alpha variant, were they not? So how—

[Dr. Noni MacDonald]

Yes, but—

[Don Davies, NDP, Vancouver Kingsway, BC]

How would those—

[Dr. Noni MacDonald]

It isn't a yes, no, zero.... We know that it does well against the alpha, the beta and the delta and it does modestly well against the omicron one. Omicron doesn't do well against any of the others. They come from two different phylogenetic trees. The big thing we worry about is that the delta and the omicron are going to come back together, and that will be a mess.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right.

I'd like to also get your thoughts on the impact of vaccination on transmission. Is there a significant difference today on a person's ability to transmit COVID-19 whether they are vaccinated or unvaccinated, or in a third category, I guess, which is unvaccinated but COVID exposed and recovered?

[Dr. Noni MacDonald]

Okay. I need to answer that, though can't be as simple as I'm sure you would like me to be.

The problem is that for the original Wuhan strain, when you were immunized, it actually totally decreased transmission as well; it did not completely eliminate transmission, but dropped it substantially. It did not drop transmission as much as it did against delta and it doesn't drop transmission very much against omicron.

Omicron is also much more contagious. It grows really well in your upper respiratory tract. You make copious amounts of this virus. It may not make you that sick, but you can spread it galore, all right?

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

[Dr. Noni MacDonald]

We need some more different vaccines that can help to decrease transmission.

Also, I was answering the question about the masks: Wear your mask. You will decrease—