Health Committee on June 1st, 2022

[Don Davies, NDP, Vancouver Kingsway, BC]

Got it.

I'll try to squeeze one more question if I can.

Dr. MacDonald, on March 31, you co-authored an op-ed in The Globe and Mail. You said:

A lack of vaccine acceptance is a symptom of ongoing mistrust that is our collective colonial lineage.

Acknowledging and supporting Indigenous peoples’ right to self-determination—the right to choose—is a critical step in addressing COVID-19 vaccine mistrust. Indigenous peoples have the right to credible and culturally-relevant information in order to make an informed choice. They have the right to question. They have the right to say “no.”

Given the direct connection between vaccination and colonialism that you are making, are you concerned that vaccine mandates could reinforce COVID-19 vaccine mistrust among indigenous people?

[Dr. Noni MacDonald]

I would hope those mandates would be done in collaboration with indigenous physicians and health care providers, so that they can literally—and I'm putting this in quotation marks—“translate” why this is being done and how it fits with indigenous views on health and well-being. I—

[Don Davies, NDP, Vancouver Kingsway, BC]

But have they done that? That's my question.

[Dr. Noni MacDonald]

They have tried and, in a number of places, have been quite successful. In others, we simply don't have enough indigenous health care providers to be able to do what needs to be done.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. MacDonald.

Thank you, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Dr. MacDonald.

[The Chair, Liberal, Sean Casey]

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

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

This is so fascinating, and I don't know where to go. I almost feel like I need to ask the other two people a question, but I'm going to go down this road a bit.

I'm not a medical expert, like most members of Parliament aren't medical experts. I come from a business background, so I'd like to think that I have some expertise in negotiation and persuasion, and that I think is relevant here.

I wrote an op-ed on vaccine hesitancy in 2019, because I have a son with autism and I would have described myself as vaccine hesitant 20-some years ago because of the Wakefield situation coming out of the U.K. My op-ed in 2019, pre-COVID, was to convince people that vaccines don't cause autism and to address vaccine hesitancy from that standpoint. I had the chance to talk to many experts about this. The approach that I took at the time, as a parent of someone with autism, was to try to understand, show some empathy and ask the types of questions that they might ask of some of the experts I had the chance to quote in my op-ed.

I am very concerned about the way that we've communicated over the last two years with people who are vaccine hesitant. I know when you're talking about politicians...I sense that you're pointing at some politicians within my own political persuasion or sphere. However, we have one prime minister in this country and that Prime Minister referred to people who don't get vaccinated as misogynists, racists, “those people” and a lot of other things.

I think people who have chosen not to get vaccinated did so largely because they thought the vaccine was going to hurt them. I think our approach should be to persuade them, based on evidence, that they should get vaccinated, because they're safer when they get vaccinated and people around them are safer.

What would you maybe do differently in terms of communication, if you could revisit the last two years?

[Dr. Noni MacDonald]

First of all, we needed much better communication out there. Communication experts know what they're doing, but they have to know the science behind it to know what it is they need to be doing. That's the general communication or the media communication.

I think your comments are really important. You have to listen to what the concerns are. You then need to find out what they know and what they don't know at the individual level. You need to see if you can offer them some information that might be helpful when you're trying to build this kind of trust. You need to find out if they understand and have more questions about what you've told them. When you do this, many of these people can move from being vaccine hesitant or resistant to saying, “Yes, I will accept it”, when it's done one-on-one like that.

It's called “mini motivational interviewing”. We've done national studies with this in Canada for routine immunization. It can be very successful. It is not expensive to do. We did not do it well during COVID. We needed many more health care providers who were trained in being able to do this, whether they were pharmacists, frontline nurses or family physicians. We needed many more people out there who could listen well and find out what the obstacles were.

For some of our indigenous populations, it was past history. For some people, it was what their local MP said. For some people, it was what their local MLA said. For some people, it was what their religious leader said. There were all kinds of people out there crowing that they knew what to do and told people what they thought they needed to do, not based on what the evidence was.

[Dr. Danielle Paes]

If I may be so bold....

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

Absolutely.

[Dr. Danielle Paes]

I have to say that I see such a strong role for pharmacists in addressing both vaccine hesitancy and misinformation. I was someone who gave COVID-19 vaccines and had this beautiful, protected time with patients, when I could make sure the experience was a positive one, so they felt confident about the informed choice they were making, told their friends, shared their experience, and highlighted pharmacists as reliable sources of valuable and important health information. That's part of it.

In saying that, I think we also need pharmacy services to be funded, so we can continue to provide care. The traditional model we've seen has been pharmacists in more of a dispensary role, but those days are gone. We really do need to access and utilize our medication experts, who are conveniently located within five kilometres of most Canadians. I am obviously biased, but I really feel that pharmacists can be part of the solution, especially as we move forward in talking about the promotion of vaccines and addressing vaccine hesitancy and misinformation—not just in the vaccine space, but drug misinformation, as well.

There's so much opportunity, and I appreciate the conversation and dialogue. I almost feel as if I were sitting in on a CE with Dr. MacDonald, so thank you very much for all the wisdom you shared in your responses.

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

I don't have time for another question, but I want to make a comment on the pharmacists' side.

I'm fortunate to live in a province—Alberta—where pharmacists have been given a more substantial role. l will tell you that it is of huge benefit to the people in Alberta. I'll just throw that out.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lake.

[Dr. Noni MacDonald]

Bad language about people who don't accept vaccines is totally unhelpful.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. MacDonald.

Next, we have Dr. Powlowski for five minutes.

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

I think we're all aware of the impacts and adverse effects that social distancing measures and lockdowns have had on people. Certainly, Dr. MacDonald, as a pediatrician, you have spoken about the adverse effects on education. I think Dr. Yu talked about the effects on the elderly, the effects of depression, and the higher suicide rate. This has created its own large umbrella of other health problems.

I want to ask you, Dr. MacDonald—an infectious disease expert. I know you're a pediatrician, so maybe you don't have as much experience with it, but I want to ask you about the value of treatment options, specifically Paxlovid. As much as possible, we want to avoid further shutdowns and having to use these distancing measures. It would seem to me that we're not doing as much as we could to get people who are high-risk treated with Paxlovid to decrease their rates of hospitalization and ICU admissions.

Do you agree with that, or do you want to comment on that?

[Dr. Noni MacDonald]

Yes, that would be helpful.

Let me reframe it for you. Is it better to prevent the fire or get to the fire early? It's always better to prevent the fire, if we can. Paxlovid is only trying to put the fire out when it's already burning. Yes, sometimes it works. Yes, it can decrease it. But it's not 100% effective. It doesn't say that, as soon as I pop that pill, I'm not going to get sick and I'm not going to have bad disease. The data are not there. I mean, it helps, but it's better if you didn't get it in the first place.

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

Yes, perhaps it's better. I certainly agree, and the dogma in public health is certainly that prevention is far better than treatment. Perhaps, though, we've gotten as far as we're going to get in terms of vaccinating people. I'm not sure how many more people we can convince.

If that's the case, is that an option, and what more should we be doing to make it available, so people who are high-risk, and doctors, are aware of the benefits of getting it early?

[Dr. Noni MacDonald]

I think the problem there comes back to what Dr. Paes was saying. It really would be better if it were widely available in pharmacies. It probably never will be, in terms of where it needs to be—that one simply needs to have a positive test that is confirmed. We don't want this taken by people who don't have COVID, but have a runny nose and a cough. It needs to be there as quickly as possible. Yes, it works up to five days, but it's better if it's before five days, when you're giving it.

I think there are many things in the system rollout that make it complicated and difficult, and I'm not sure we'll ever get that smoothed out. We can do better, but it will never be lickety-split out the door.

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

I was going to ask Dr. Paes about this because pharmacies in Quebec are prescribing it. How has that worked? Is there anything in the Quebec regulatory system that has allowed them to do it but prevented other provinces from doing something similar?

[Dr. Danielle Paes]

Thank you so much for the question.

As of April, 4,500 patients in Quebec have received Paxlovid, and about 70% of those prescriptions have been written by pharmacists. A key enabler, I would say, has been virtual prescribing, so that symptomatic patients don't show up at the pharmacy door. The Quebec government has recognized the complexity and the time needed to ensure safe prescribing, and providing pharmacies with the appropriate funding and resources to do this has been instrumental in increasing that access.

Patients are able to have home deliveries for the rapid antigen test. They're able to confirm their diagnosis. They're able to consult with their pharmacist over the telephone. It's a very well-thought-out model, and it's working. We're starting to see that trend in Alberta, Newfoundland and Labrador and Saskatchewan, and as these provinces work within the regulatory relations to enable them to remove these barriers, I think we're going to really be able to improve access. The impact that will have on COVID and getting rid of it and getting us back to normal, I think, will be significant.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Paes and Dr. Powlowski.

Mr. Garon, you have two and half minutes.

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

Thank you, Mr. Chair.

Dr. Yu, you talked about the importance of research, funding it, and the quality of researchers, which really caught my attention. Just yesterday, in the House of Commons, the Bloc Québécois tabled a motion proposing an increase in scholarships awarded by the three agencies, meaning the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council of Canada. In our view, this would improve diversity in the pool of researchers, who will one day become university professors, for example.

Do you think we should increase scholarships to enhance the value of the research profession, particularly for people from diverse backgrounds?

[Dr. Wai Haung Yu]

Thank you very much for the question, Mr. Garon.

I do agree that tri-council funding should be increased, and that shouldn't necessarily be at the expense of other programs like the CRC or the CFI. They are all really important for maintaining and innovating for research in terms of equity, the diversity of research, as well as the diversity of individuals who can....

I think one of the most difficult factors right now, especially for tri-council funding, is what we are going to with the next generation of scientists. I've been around for quite a while, and I'm happy and delighted when I see early career researchers getting their funding. For example, my post-doc just got funding from an agency a couple months ago. These are celebratory events, and they're not happening enough these days.

Let me give you one stat. Because of funding levelling off for research, we really haven't had an increase for early career researchers since 2003. That's going to affect the future of research, which is going to affect the ability to attract talent. Funding like that from the tri-council is essential for making sure that the landscape has that parity and that innovation for the future.

Thank you very much for the question.