Health Committee on Oct. 18th, 2022

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Thank you to our witnesses for your appearance today and for your extraordinary work over the last couple of years, which have been one of the most important and difficult times for Canadians and certainly for the health care sector as well.

I would just like to point out that I think most Canadians recognize, Dr. Tam, what your role is as the chief medical officer of health for the Public Health Agency of Canada. You're not a politician, and travelling around from community to community to liaise with Canadians isn't part of your mandate.

I would also just like to say that, in general, Canada is in a good place today, and that's in large part due to the fact that we've had reasonable restrictions and a very high vaccination rate. There are still, tragically, 45,000 deaths in Canada as a result of COVID-19, but if we had numbers similar to the United States, that number would be triple, and that's a daunting thing. An additional 90,000 Canadians wouldn't be with us today if we had different restrictions. That goes for France, Sweden and Spain also, which would indicate that those figures would be double. By all accounts, I think Canadians have a lot of confidence in our public health care system and public health in general, and I want to thank you, on behalf of all Canadians, for the extraordinary work you've done.

I'm just having a little bit of trouble hearing myself. There is a lot of chatter going on in the room, and I think it's important that we all recognize that we have time to speak and time to listen in this room.

Dr. Tam, we have seen recently in the media that Canadians are starting to become a little bit tired of keeping up with vaccinations. There is a sense a lot of Canadians have that COVID-19 is over or that they don't need to worry about COVID-19 anymore. We're fortunate to be in that situation, due in large part to the number of Canadians who have gone out and had a vaccine.

However, it is important, as spokespeople for our communities and as elected officials, that we provide Canadians confidence and information with respect to vaccines. Could you share with this committee how we can all work with your agency and among ourselves to increase confidence among Canadians and give them all the information they need in order to go out and get vaccinated and continue this positive trend that we're all fortunate enough to be experiencing?

[Dr. Theresa Tam]

Mr. Chair, I want to thank the member for that question. My colleague, Mr. Stephen Bent, vice-president of the vaccine rollout task force, can supplement my answer.

My previous response describes some of our seven-point immunization action plan, which aims to boost the confidence of Canadians for the bivalent vaccines. That includes communicating with Canadians in the different ways and formats that I've outlined.

Through numerous surveys, we know that Canadians trust their health care providers, so providing information to our pediatricians, physicians, nurses and pharmacists who are on the front lines, so that they can answer questions from the public, is very important, as well as clearly communicating what is now quite a clear message from the National Advisory Committee on Immunization, which is to get a booster if you haven't had one or if you haven't had an infection in the last six months. This is actually a very clear message that all of you and others could communicate, as well.

Then it's building trust, of course, with communities that have been disadvantaged and have experienced inequities over the years and working with them so their leadership can provide the voice to their populations to take action to get a booster. We're providing funding, through grants and contributions, to specific communities to help them improve the vaccination rates.

Maybe Mr. Bent would like to add something to my response.

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

Thank you, Dr. Tam.

[Brendan Hanley, Liberal, Yukon, YT]

Mr. Chair, I have a point of order.

I'm having a hard time hearing the response. There's a lot of chatter in the room. I wonder if you could address that.

Thank you.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Mr. Chair, I'll also weigh in on that. I know there are a few new members around the table. As someone who's been here for seven years...we have these handy little headsets that they can absolutely put in if they'd like to. That's free advice for the new members to listen to if they're having so much difficulty hearing.

[Adam van Koeverden, Liberal, Milton, ON]

It's still my time, Mr. Chair, and I would like to say that we all know about these. That was fairly condescending, to tell us that we have a way to listen, when—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

It's not condescending. Come on, Adam.

[Adam van Koeverden, Liberal, Milton, ON]

If the witnesses were in the room, talking over them would be seen as an extraordinarily disrespectful thing to do. It's fine to talk in a group if you'd like to avail yourself of any of the other spaces in this room. If the witness was in the room, you would not be talking over the witnesses like that. It's extraordinarily rude. I noted that you were doing it while I was asking my question, as well. It's extremely distracting.

We're here to work, and we're here to listen to these witnesses. If you're not interested in listening to the witnesses, then use another part of the room.

[The Chair, Liberal, Sean Casey]

If we could show respect for one another and for the witnesses, that would be greatly appreciated.

Mr. Bent was about to offer an intervention.

If you could keep it brief, Mr. Bent, then we're going to retreat to our corners and move along. Thank you.

[Stephen Bent]

Thank you, Mr. Chair.

I would only add that this year alone we've been able to invest an additional $5.3 million in projects to reach under-reached and marginalized communities, including indigenous and racialized communities.

I would also add that in the context of vaccine confidence, we continue to work with the provinces and territories and with the regulator in terms of vaccine safety and ensuring that Canadians have the latest, most up-to-date information in terms of the overall safety and efficacy of the vaccines that we have available to us. That's a really important part of this space, as well.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

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

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

Thank you, Mr. Chair.

Dr. Tam, I still feel that public trust remains the most important asset for a public health agency. Such an agency gives directives to people; it does mass medicine and asks people to follow those directives.

The pandemic is obviously still with us, but we are taking stock of a number of things.

During the pandemic, many people in the public had difficulty distinguishing between politics and science. It was hard to know what specific recommendations you had made to the government and what analyses you had given them.

It was difficult to know which parts were political. It's good that there is political involvement, because politicians are elected to make decisions, especially on social cohesion. I am not here to put your agency on trial. In fact, I think it has done a good job.

I wonder what could have been done differently to increase public confidence in the scientific process that led to health measures, mandates, and vaccination, among others.

Dr. Tam, I don't want you to waste my remaining time telling me what you did. I would like you to tell me what you would have done differently and what could have been done differently.

Communication is part of the scientific process in public health. I am not asking you to play politics, but rather to tell me what should have been done differently.

[Dr. Theresa Tam]

Yes, trust is really important. I am not a politician, as you rightly pointed out. Because we're dealing with extremely complex decisions, it is ultimately the political decision-makers who make those decisions. We provide both technical information to them and, of course, communication with the Canadian public.

There's a lot to be learned, I think, about how we communicate uncertainty when we don't have every piece of data that we need and, of course, how to navigate and bring the population along as things evolve. That happened throughout the pandemic because the virus was new. We had to learn practically every day about how it's changing and what measures can be done to reduce its impact. That is very critical to future pandemic preparedness.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next is Mr. Blaikie, please, for two and a half minutes.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

I think for most people, when they think about their experience of the pandemic, there's the personal side in cases where they may have a friend or family member or themselves who got very ill and all the anxiety and worry that come with that. We talked a fair bit about vaccination already, which is of course the best way to try to prevent similar instances in the future.

The other thing I think is part and parcel of people's experience of the pandemic, even if they didn't get sick with COVID themselves, was just the extreme strain that it put on hospitals. They may have experienced that in the case of a loved one. They may have experienced it in their own case, requiring health services for something that was unrelated to COVID but where the treatment and the availability of health resources were severely impacted as a result of the level of infection and just how difficult it was for the health system.

In this moment of, relatively speaking, apparent calm, I'm wondering what we can be doing in order to try to strengthen health systems and shore up our hospitals in the event that we do see another wave or something else that comes along that requires a significant amount of health resources.

I know that provinces, of course, are responsible for that direct delivery, but in health human resources, for instance, we're going to need to train more people. Having 10 different provincial strategies that are competing and might incorporate poaching, for instance, as part of their strategy will not be helpful. Some kind of national collaboration and co-operation might help there.

I'm wondering if you could point to other areas where co-operation among provinces and with the federal government might help us develop a faster response or to be ready more quickly for events that may be coming down the line.

[Dr. Theresa Tam]

Given the nature of a pandemic and the complex public health challenges, there has to be a huge amount of collaboration between provinces, territories and the federal government. No level of government can do this alone.

In terms of the health care system pressures, on the public health side what we're trying to do is promote prevention and health promotion so that we reduce the impact on the health system. It's very important to have emergency rooms, primary health care and other systems being more resilient. Part of the solution is actually shoring up public health. You've seen in the pandemic that if vaccinations and other measures were not put in place, those very systems would be even more pressured than they were before. We need to protect our health care workers.

Those kinds of collaborations are absolutely key. Of course, we need to collaborate on monitoring and sharing of information and data to inform our collective response, while recognizing that there are different contexts, different populations and indeed different virus activities on the ground.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Next is Mr. Jeneroux.

Welcome to the committee. You have the floor for the next five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair. Despite my earlier intervention, it is a real pleasure to be here with every single one of the committee members, but also to be back at the health committee.

Dr. Tam, it's good to see you once again.

Dr. Njoo, it's been a while since our very many meetings back in early 2020 in the lead-up to the pandemic, but that's kind of where I would like to start, if we can.

There are a number of quotes here that I know have been associated with you, Dr. Tam, which I'm going to read, and then I would like you to perhaps reflect upon what we could do differently or next steps that could have perhaps been taken earlier to prevent the rapid spread at the beginning of the pandemic.

First of all, you said, “Canadians should not be concerned that they can pick up the virus from an infected individual by any casual contact, such as walking through the airport or another public place.” Dr. Tam, that was you on January 27, 2020.

“Dr. Theresa Tam said again that sealing off borders is not an effective approach to containing the virus.” That was you, Dr. Tam, on March 4, 2020.

“[P]utting a mask on an asymptomatic person is not beneficial.” Dr. Tam, that was you on March 30, 2020.

Dr. Njoo, I certainly won't miss a quote from you as well. On February 26, 2020, you stated, “We have contained the virus.”

Again, in terms of perhaps what you can do differently at the beginning of a pandemic and steps to stop the rapid spread, I would love to hear your insights based on those quotes.

[Dr. Theresa Tam]

Mr. Chair, I'll start.

Thank you to the member for those questions. Part of my reflection on lessons learned is that hindsight is 20/20. Information and the evolution of the understanding of the virus are changing all the time. At that point in time, at the end of January, we were very good in Canada to be able to pick up our first case. There was no discernible community transmission at that moment in time. However, as everyone could see, things were evolving fairly rapidly.

For pandemic preparedness going forward, I would suggest that we need to increase global collaboration, share information more rapidly if possible, and reduce the rapidity of transmission from the original source if we actually know where it started. However, the way this coronavirus was transmitted changed over time. At the beginning, the R value, what we call the reproduction number, wasn't that high, and then it just kept gaining more and more momentum. Then our understanding of asymptomatic transmission came into play. That's when we really stepped up the recommendations for mask wearing, when it was much better understood.

We need to have humility in the face of these viruses, for sure. I'm sure there's a lot we can do, but shoring up public health is a really important aspect of preparedness going forward.

[Dr. Howard Njoo, Deputy Chief Public Health Officer, Public Health Agency of Canada]

Mr. Chair, maybe I could add something in terms of the comment attributed to me. If I recall correctly the date, those comments were actually made at the health committee here. Certainly, if we look at the larger context, what was indicated at that time—which was, as Member Jeneroux reported, February 26—was that certainly with our efforts to date, at that point in time the virus had not obviously transmitted to a large degree. If you look at all of the comments I made, I said we continued to work closely with the provinces and territories in terms of planning for a potential worst scenario.

One of the things I did mention, I do recall, at that committee, was things that were unknown at the time, things like public health measures. I said that we were not at that point yet, but we had to start thinking about potential measures like social distancing, which at that point in time was something totally unheard of, and looking at what might need to be done in terms of schools and other maybe more restrictive public health measures.

I think you need to take the whole context of everything that was said and what we knew at the time. And certainly, as Dr. Tam says, I think we do have humility. As the science evolves, statements made or what we say and do at a certain point in time based on the state of science at that point in time certainly evolves with—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I'm sorry to cut you off, Dr. Njoo. I know I have about 10 seconds left. Just quickly, are the Public Health Agency of Canada and Health Canada planning to conduct a full review and report on the handling of COVID?

[Dr. Theresa Tam]

As I said, that decision is not up to me. However, as I reiterated before, lessons learned are very important, with the view to improving our response going forward.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Next we have Dr. Hanley for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you, Mr. Chair.

First, I'd like to add my congratulations to Dr. Ellis for being elected vice-chair.

I'd also like to welcome our new member, Mr. Jeneroux, to the committee. We enjoy a productive and collaborative committee here. I'm sure, as a new inductee, you'll learn quickly from your more experienced colleagues around the table.

Dr. Tam, it's good to see you again. I also want to add a comment—a reflection from my previous role pre-Parliament—on your connection to rural and remote Canada. You are a vital advocate for rural, remote and indigenous Canadians. I think a good example was about a year and a bit ago. There was a live Facebook update on a weekend with famous Yukon bhangra dancer Gurdeep Pandher, and a Q and A for Yukoners. You found many ways to connect with rural Canadians. That may be reassuring for Mrs. Goodridge.

On the note of the important theme that was just in the last questions answered, I wonder if you could comment, from the point of view of lessons learned, on how we work with evolving evidence through a new viral threat, like this COVID pandemic—there are many other examples—and adapt guidance. Perhaps you could reflect on the specific example of the new integrated risk assessment, and how that new unit is helping to provide that ability to keeps eyes around the world and adapt to risk and guidance quickly.

[Dr. Theresa Tam]

Mr. Chair, I thank the member for the question.

Of course, to add to my previous answers, we've been looking at lessons learned throughout the pandemic and evolving our response as we go along. We had OAG audits. We've been responding to those as well. We've also had external experts look at our risk assessments and the global public health intelligence network, and how we can better utilize that.

Yes, we took all those lessons and recommendations into account when we established a new centre for integrated risk assessment to bolster our risk assessment capacity. It was established in December 2021. We now have increased capacity to integrate different streams of scientific information, not just from data and monitoring systems, surveillance and ways forward, etc., but also from the scientific literature, which is certainly making it easier for us to produce risk assessment and threat reports. We're now using this centre and the methodologies to integrate laboratory genomics, epidemiology and clinical information of new variants of concern, and those updates have been shared with provincial, territorial and other partners as well.

While the methodology is being stabilized, we should be able to provide more of that in the public domain—although it's very technical information—so that people can see in a more transparent way how integrated risk assessments are done.