Health Committee on Jan. 18th, 2022

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

If time permits, I have two questions for Dr. Tam.

Dr. Tam, I think it would be very useful if you could talk a bit about the modelling, the projections and the surveillance that you and your team take on to inform the advice that you and your colleagues provide to the ministers.

In my role as an MP, of course I am asked by many people about what we are looking at post-omicron. What are the possibilities including for border controls and for tourism and the ability to open those up a little bit? It would be useful to go back to how you, even in the midst of omicron, project ahead and on what you base the advice that eventually will come on how we adapt our border requirements and other measures.

[Dr. Theresa Tam]

Thank you for the question.

Mr. Chair, this is quite a complicated question. Of course, maintaining surveillance as well as keeping an eye on all the evolving international data on omicron is really important.

First, we have laboratory networks, including genomics networks, connected to the international community that are on a constant lookout for any new variants of concern. They're also conducting domestic surveillance with the collaboration of the provinces and territories to look at not just cases but hospitalizations and ICU admissions as well as outbreaks in high-risk settings such as long-term care facilities. Monitoring vaccine effectiveness over time is really important as you've just seen. With the advance of treatments you need to also monitor for any resistance to some of the drugs that are being provided.

We know, for example, that some of the monoclonal antibodies were not working for this omicron virus. There are many streams of surveillance, data and modelling.

One of the key innovations during this pandemic is waste water surveillance, which is another indicator we're using to track where the omicron wave is going and when it might subside. All of these measures are ongoing as is modelling. Modelling projections we have been providing on a regular basis, the last of which was last Friday.

We have to be very careful with the projections. We think the omicron wave might spike very quickly and potentially come down fairly quickly as it has done in other countries but we have to be very careful about that. Right now we're seeing a little bit of plateauing in the cases. I advise that we wait until at least the end of this week to have another snapshot of what's going on. Given the testing limitations at the moment, we need to look at all of these indicators.

I look at the current context as the pandemic period, which is that we are still in crisis and our health care system cannot cope, moving to an interim transitional period towards a state of endemicity. This means I do not believe that this virus is going away from the world. Every country has it, so we need to adapt our response going forward. However, the endemic state is not yet in effect. The omicron wave may push us towards that state—one step into that future state. We have to evaluate the post-omicron wave using things such as sero surveys, whereby you look at the proportion of the population that might have immunity.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

In as much time as we have, Dr. Tam, you recently published a report, which I personally think is extremely important but many Canadians may not be aware of it. That report is called “A Vision to Transform Canada's Public Health System”.

Could you take a moment to point to some of the highlights and recommendations arising from your report?

[Dr. Theresa Tam]

Yes. I think the committee has noted that we need to strengthen Canada's health system, and my report is focused on the public health system, but it's part of the health system as a whole. Given the enormous challenges of the pandemic, my message is also to recognize the prevention, health promotion and preparedness aspects, not just the response. We need to get ourselves well set up for any future complex public health issues, including climate change and anti-microbial resistance.

My recommendations really fall into four different streams, one actually on workforce capacity, and the second on some of the tools that are needed to modernize our health system, and this means at every level of the public health system, not focused on the Public Health Agency, but on the local, the provincial and the federal systems, so that we're better set up with data, for example, as one of the tools, and also to address things like misinformation in the social media age.

The third aspect is governance. We need to have a modernization of governance, recognizing the multisectoral nature of some of the work we do, including the pandemic response, and of course the financing of the public health system as well, because it is a very small proportion of the health spending in different jurisdictions. It's very difficult to estimate how much that budget is, but CIHI, the Canadian Institute for Health Information, estimates it is probably not more than 6%. If we want to be better supported in our pandemic response in the future, we've got to strengthen the public health system.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Thank you, Dr. Hanley.

We will switch to Monsieur Thériault for two and half minutes, please.

Mr. Thériault, you have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, do I still have two and a half minutes, or is it five minutes?

[The Chair, Liberal, Sean Casey]

Your speaking time is two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Well, I tried.

[The Chair, Liberal, Sean Casey]

Mr. Thériault, you haven't changed parties. This is the time allocated to members of the third party.

Your time is two and a half minutes, and it starts now.

[Luc Thériault, Bloc, Montcalm, QC]

I would like to talk about rapid tests.

As mentioned earlier, it's good to have antivirals, but we have a problem if we don't have access to rapid tests and the antivirals are not very effective after five days.

I would like to know when Merck's antiviral will be approved. It has already been purchased and this was filed in August. If it hasn't been approved yet, is it because there is a problem?

Why don't we trust what the experts say about rapid tests? We could produce a lot more of them if, on a temporary and extraordinary basis, we allowed some of the rapid tests that have been approved in other countries. Why don't we do that here? We have the antivirals now, but they have to be administered quickly to be effective.

[Dr. Stephen Lucas]

Mr. Chair, I'll respond.

Health Canada has approved 25 rapid tests and, in addition, 10 self-tests. This is comparable to other countries. In fact, it exceeds a number of our key comparator countries. These cover a range of antigen tests and some molecular rapid tests. As has been described, we're working with Public Services and Procurement to procure and deliver 140 million to provinces and territories this month.

In regard to utilization, provinces and territories are using rapid tests as well as PCR tests to support key areas of both diagnosis and critical functions, including in the health system, long-term care, schools and essential services. Dr. Tam can speak further, if you wish, to use guidance prepared by the Public Health Agency, with experts, in terms of enabling both test diagnosis and utilization of Paxlovid.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Lucas, some experts say that more could be approved if this measure were taken. What they say, and what is problematic, is that your criteria are too strict and inadequate, since rapid tests are compared to the PCR test. Instead, they should be assessed on their ability to identify infectious patients.

Why not increase their potential approval by changing the criteria and making them more accessible? It's all very well to say that 140 million rapid tests will be sent to us, but there could be more. This is important.

We spend money on antivirals. But if we don't have access to PCR tests, we can't use them effectively. There are other issues as well.

[The Chair, Liberal, Sean Casey]

Could you give us a brief response if possible?

[Dr. Stephen Lucas]

Certainly. What I would say, Mr. Chair, is that Health Canada's standards for reviewing rapid antigen tests for screening purposes align with those of the U.S. Food and Drug Administration in terms of the levels of specificity and sensitivity. We do review clinical evidence that they work, and therefore we have not had to recall tests, in contrast with some other countries that have deployed rapid tests that don't work and that have had to recall them.

We have approved 25 rapid tests and 10 self-tests and we have pursued those approved in other jurisdictions and have invited them to submit those to Health Canada to undergo expedited reviews.

That work continues with many tests under review and further decisions expected in the coming days and weeks.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lucas.

Mr. Davies, go ahead please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

To anybody who might know, in the fall of 2020 the safe restart agreement aimed to increase Canada's collective PCR testing capacity to 200,000 people per day across the country.

Can you confirm the average number of PCR tests administered across Canada over the last seven days?

Can anybody answer that?

[Dr. Theresa Tam]

Yes. May I answer the question, Mr. Chair?

[The Chair, Liberal, Sean Casey]

Yes, Dr. Tam. Go ahead.

[Dr. Theresa Tam]

Yes. On average, we have been doing over 148,000 or 150,000 tests, with any rate-limiting steps not necessarily related to the number of tests that can be run but related to human resources and other testing capacity challenges within the provinces and territories.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Dr. Tam, are all Canadians likely to be exposed to and get infected with omicron as many experts have predicted? Is that your assumption?

[Dr. Theresa Tam]

Where there's a very transmissible virus, the likelihood of contracting it is much higher than with other variants. I do think that people still have varying risks, but the likelihood is much higher.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

So with that growing global recognition that omicron, that COVID-19, may soon become endemic, does societal immunity, particularly through virus exposure, which may be likely to provide some level of effective immunity, play a role in this change?

If so, are we collecting seroprevalence data as the U.K. is doing?

[Dr. Theresa Tam]

On the latter, yes, there have been ongoing serologic surveys. That's why I also mentioned earlier on that it would be very important to know after this omicron wave what kind of immunity there is in the population.

But we also have to remember that the immune system is a complex thing, and so protection from infection is different from protection from serious outcomes. We're particularly concerned and very interested in protection against serious outcomes, for which the vaccines are actually doing quite well.

I think that protection from infection is going to be short-lived no matter whether you're infected with the virus itself or you have had a vaccination, so that remains to be monitored.

[Don Davies, NDP, Vancouver Kingsway, BC]

Now the European Medicines Agency recently warned that frequent COVID-19 booster shots could adversely affect the immune system and may not be feasible. They stated that boosters “can be done once, or maybe twice, but it's not something that we can think should be repeated constantly.”

Dr. Tam, do you share that concern? If so, what is Canada's next step after third or fourth booster series are complete?