Health Committee on June 8th, 2022

[Dr. Theresa Tam]

Well, when the mandates were implemented there was a strong resurgence of the delta variant and the vaccines were very effective, even though there were the beginnings of some waning immunity. Even two doses are effective against infection and, of course, serious outcomes.

Omicron is a game-changer, in that you really need to increase the number of doses of vaccine. Three doses would boost your immunity against infection, and definitely for serious outcomes, so these things need to be considered. Given the reduced vaccine effectiveness against the omicron variant, even with three doses, vaccines alone cannot prevent full transmission, so a layered approach has to be considered, including layering mask-wearing, for instance, but these are the things that the relevant ministers need to consider on the path forward.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Lucas, the mandate letter to the minister last December says there's a direction to “promote healthy eating by advancing the Healthy Eating Strategy”, and that “includes finalizing the front-of-package labelling to promote healthy food choices and supporting restrictions on the commercial marketing of food and beverages to children”.

Can you confirm when restrictions on the commercial marketing of food and beverages to children will come into effect and when front-of-package labelling might be in place? Are we months away? Are we years away?

[Dr. Stephen Lucas]

Mr. Chair, both of these initiatives are being pursued. The government gazetted in the Canada Gazette, part I, draft regulations on front-of-pack labelling, I believe, back in 2019. Stakeholders have been re-engaged in late winter and spring, and work is moving forward to advance that initiative in the months ahead.

In regard to work on marketing to children, the government and Health Canada have been working specifically with a range of stakeholders: health stakeholders, patient groups—

[Don Davies, NDP, Vancouver Kingsway, BC]

With respect, Mr. Lucas, the question was “when”, not what you're doing. When can we expect to see that?

[The Chair, Liberal, Sean Casey]

Respond quickly if you can, please, Doctor. We're past the time.

[Dr. Stephen Lucas]

I did respond in regard to front-of-pack labelling.

In regard to marketing to children, work is under way. There is a private member's bill before the House. The government is watching the parliamentary process. We're working with stakeholders. The industry has provided a voluntary code, and we will continue working on this in the months ahead to address this important issue as well.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lucas and Mr. Davies.

Next we have Dr. Ellis, please, for five minutes.

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

Thank you, Mr. Chair. I have a quick question for Dr. Tam.

Did I hear correctly that you said that three doses of the vaccine is about 60% effective?

[Dr. Theresa Tam]

Thank you for asking for that clarification.

Three doses of vaccine against infection in symptomatic disease soon after you get that third dose is about 60%, but the studies range in their estimates, and for severe disease it is over 90%.

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

It's interesting, Dr. Tam. This is just a comment, but for varicella, the mortality rate was about 21 people per 100,000 in adults, and a perhaps more effective vaccine was supplanted by another. I find it unusual that you continue to recommend this vaccine that's not very effective.

Anyway, that being said, interestingly enough, masking mandates are stopping in Ontario on public transit and other various health care settings except long-term care homes.

I wonder, does Dr. Moore have some metrics that perhaps he needs to share with the Public Health Agency so that we can have some numbers here? Would that be helpful to the Public Health Agency of Canada?

[Dr. Theresa Tam]

The requirements for domestic transportation are in the domain of the Minister of Transport. Whether someone requires you to wear a mask or not, I would recommend that people add on that layer of protection, especially if the viral activity is high in your area, whether someone has requested or required it or not.

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

Dr. Tam, are you suggesting that Dr. Moore is wrong?

[Dr. Theresa Tam]

I didn't say that. In terms of the local jurisdiction, they will know more than I do about the disease activity, but for the general population, I still advise people to layer on that protection, particularly if they're at high risk and to protect others.

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

Those are interesting comments. Thank you for that.

We've talked a lot about metrics and numbers, and I have a very pointed question. What is it that makes the Public Health Agency of Canada afraid to share those numbers with Canadians? What are you afraid of?

[Dr. Theresa Tam]

It's a question of people needing to understand the complexity of public health decision-making. You cannot make these very complex decisions based on a singular metric. The decision-makers have to take into account a number of metrics, even looking at health care capacity, which is different across Canada. It's not the same between Yukon and Ontario. As the federal government, they need to take that into account and make sure they're protecting all populations across Canada with some of the mandates they are responsible for.

You have to look at a composite picture of all those metrics or measures that Dr. Kochhar mentioned. It's not that simple. You cannot boil down a complex decision by simple metrics; all of them are important.

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

Yes. Thank you for that, Dr. Tam.

If I could, Mr. Chair, oddly enough, we've asked for those metrics to be presented here at this committee. This is not to be disparaging to my other colleagues, but there are three physicians on this committee. The Public Health Agency of Canada has refused—over and over and over and over and over and over again—to provide these metrics. I would dare say that perhaps three physicians might be able to understand this very complicated stuff they're talking about.

Dr. Tam, I find it utterly shocking, dismissive, and quite frankly unbearable that you continue to refuse to provide this. There have to be some metrics. This is utterly ridiculous. To not provide them to this committee is embarrassing, quite frankly.

[Dr. Theresa Tam]

As far as I know, the Public Health Agency of Canada, as part of the remittance from the last committee, provided the answers that this committee was looking for. The president of the agency has—

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

I'm sorry, Dr. Tam, but that's absolutely untrue. I'm the one who requested that material. The stuff we got talked about the same foolishness. I'm sorry to be disparaging to Dr. Kochhar and to the minister, but it was the same foolishness that we hear over and over again, that vaccines are very helpful. Yes, they are. We're fine with that. Tell us the metrics. It's simple.

It's unbelievable. This is unacceptable, Dr. Tam.

I have nothing else.

[The Chair, Liberal, Sean Casey]

Dr. Tam, you go ahead and respond to that. Then we'll move on to the next questioner.

[Dr. Theresa Tam]

I think the metrics are what they are. When you're looking for specific numbers, it's actually really difficult to do that, because you have to take into account all those metrics at the same time. They include what I've talked about, which is vaccine effectiveness, of course. The current two-dose vaccine regimen is not enough, so as chief medical officers we said that up-to-date vaccinations are what we recommend.

The other metrics, if you're looking at this, will be the pandemic activity across the world. In the United States it's still going up. In Canada the current wave has come down. That's great, but hospitalization is still high, and it depends on where you are.

I believe that kind of information has been provided to this committee, but we can certainly follow up.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Mr. Jowhari, go ahead for five minutes, please.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to the officials for appearing in front of the committee.

I want to go back to COVID-19 spending, specifically as it relates to supplementary estimates (A).

We know that in the supplementary estimates (A), $1.5 billion was allocated to PHAC. When you do a deep dive, you realize it's in support of therapeutics and treatments, which is, in my view, a good sign. As you all know, we started with huge spending on vaccines, PPE, research and development, building domestic capacity and buying a lot of testing.

In this budget, we are now turning our focus to therapeutics and treatments. Specifically, I want to point back to the comment the PBO made on this expenditure. He mentioned that the shift from funding medical research and vaccine development to therapeutics and treatments represents “the changing needs over the pandemic stages”.

My question for the department—for Mr. Lucas—and for Dr. Tam and Dr. Kochhar at PHAC, is this: Do you foresee future alterations to government expenditure on COVID-19 as a result of these changing needs? What should we be looking at in supplementary estimates (B) and (C) relating to these types of needed investments?

[Dr. Harpreet S. Kochhar]

Specifically, as pointed out, the supplementary estimates (A) provide re-profiling, both for aspects of therapeutics and making sure we are well prepared. As Dr. Tam pointed out earlier, COVID is not over yet, so we continue to build from where we started.

As we move forward, and as was mentioned, the medical countermeasures will still be very effective tools we would likely want to have in our arsenal in order to make sure we are prepared. In fact, a lot more emphasis will be on preparedness as we go further, whether it's on capacity-building or using new tools. In that context, when we talk about...whether it's domestic biomanufacturing or health human resources, those are all important components in terms of us being ready and the investment being there.

In reality, the lessons learned from this pandemic allow us to make those strategic investments, whether they're in capacity, expertise or tools, including medical countermeasures and therapeutics we can utilize as we move forward in our quest to get past this pandemic.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

Do any of the other officials want to make a comment? Where do we see the future investment?

[Dr. Stephen Lucas]

We are actively watching for developments in new types of treatments, whether it's treating after diagnosis or prophylactically in advance, such as with Evusheld from AstraZeneca. There's the evolution of monoclonal antibody treatment, which we know varies in effectiveness with the nature of the specific variant. There's the development of new formulations for vaccines that consider the original virus strain as well as variants, such as omicron.

These are important developments that the public health agencies, Health Canada and CIHR, from a regulatory perspective, are tracking to ensure that Canadians can have access, in a timely fashion, to the most effective vaccines and treatments.

Similarly, in terms of—