Health Committee on Oct. 18th, 2022

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Mr. Garon, you have six minutes.

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

Thank you very much, Mr. Chair.

I thank all the officials for being with us today.

I will continue in the same vein as my colleague. It's always impressive to be surrounded by doctors, so I'll try to ask questions as intelligent as his.

There was a sense of fatigue among people who had had one, two or three booster doses of the vaccine. Now, with the arrival of the bivalent vaccine, there is a sense that there is a new interest among the public. People are starting to talk positively about vaccination again in the media.

Do you think this is the right time to increase vaccination and booster rates, which have lagged substantially in recent months?

[Dr. Theresa Tam]

Thank you very much for this question.

This is an incredibly timely question, because our public research and surveys have demonstrated that people are interested in an updated vaccine. People do understand that respiratory virus season is upon us, and people are going to get further and further into gathering indoors, going to school, and working on site. All of this means that there does appear to be a rising interest, which is really great.

We do have a seven-point action plan to help Canadians improve uptake. A lot of that, of course, is working with the provinces, territories, and local health units. You've seen the campaigns rolling out now. You're going to see more and more messaging going out in the next days and weeks. The momentum is gathering.

From the Public Health Agency perspective, we've launched ad campaigns. One is called “Lots of Questions”, which was launched at the end of August, and the other ad campaign is called “Take Action”. One of our key strategies is to support communities that may have lower vaccination coverage, equity-deserving communities, with multilingual formats and targeted mailouts to populations where vaccine uptake is lower and there is high community spread.

Of course, there are social media campaigns, shareables and partnering with stakeholders, including private sectors, as well as press conferences. It really does take the engines of local public health to get the campaign rolling. We're also going to start the influenza campaigns. We're encouraging people to get both if they're eligible.

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

Thank you.

Although I'm very optimistic and fully intend to receive the new bivalent vaccine as early as next week, I feel that it may be losing the information battle. For example, at the time it arrived in Canada and began to be administered, Agence France-Presse was reporting comments from the World Health Organization, WHO, that there was not yet enough data to recommend vaccines against COVID‑19 specifically targeting the Omicron variant.

For example, the general public is under the impression that they are being told by Health Canada to get the bivalent vaccine, while at the same time there are messages that the WHO is not recommending it because there is not enough data.

Can you explain how the general public should understand these announcements made by the WHO?

[Dr. Theresa Tam]

It is very important that we communicate clearly with Canadians. The National Advisory Committee on Immunization has been very clear: If you haven't had a booster or you haven't been infected within the last six months, please go and get your vaccine up to date.

This is after Health Canada, of course, has done its evaluation on safety on the immunogenicity data that manufacturers are able to provide and some of the clinical data, for example, from the Moderna vaccine manufacturers. All of this has been taken into account to provide the information for the recommendations.

Given that Dr. Tunis is on the panel, I'm wondering if I could pass the mike over to him to provide a bit more detail.

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

I will clarify my question to make sure it is clear.

When the WHO states that it does not have enough data to recommend these vaccines, it is seen as a contraindication by the general public, who have not studied epidemiology or virology.

Can you explain clearly what the WHO means when it announces this publicly?

[Dr. Matthew Tunis, Executive Secretary, National Advisory Committee on Immunization, Public Health Agency of Canada]

Thank you, Dr. Tam.

Thank you, Chair, for the question and the opportunity to respond.

It's an excellent question. Part of the challenge we see here is that we have an expert advisory committee like NACI, which provides expert and evidence-based advice to provinces and territories and to the Public Health Agency of Canada, which then turn it into communication materials. What we see is a very motivated and interested media and public who like to look straight to the source to see what the advice is from the advisory committee. There's some complexity, I think, in the communication pathways there.

Something we've seen throughout the pandemic and throughout the vaccine program is that NACI has consistently given advice in real time as evidence continues to evolve. What the member may be referring to is when the bivalent vaccines were first introduced to the booster program. As Dr. Tam mentioned, NACI recommended that the bivalent vaccine could be used as a booster option and that boosters were important, particularly for the elderly and with the six-month interval, as Dr. Tam outlined. As the product environment has evolved and as the evidence has strengthened about the bivalent boosters, NACI recently recommended that bivalent vaccines are now, in fact, preferred for those in the authorized age groups, where they're available.

Again, this demonstrates an evolution of the science. The expert advice moves along as the science strengthens and evolves, and then the committee adjusts the strength of its recommendations. It is now clear that there are two good options for this bivalent product, and the committee was of the opinion that this would be preferred now. That is a strong recommendation for the bivalent product as being preferred, whereas earlier in the program it was being onboarded as one of the many important booster options.

I think this is something we'll continue to see occurring. As expert advice is evolving in real time—and we know that COVID-19 evidence and vaccine science are evolving as quickly as possible—we're all very closely reading every preprint and every publication that comes out to try to get the edge on the virus and get the edge on the best science. That's a function of the system of this medical and evidence-based advice coming through in real time as things are evolving.

As Dr. Tam mentioned, the important takeaway is that at this point, the bivalent vaccines—those boosters that are approved for several age groups—have been shown to have high levels of antibody, which we expect will result in protection against omicron and the other variants. The goal this fall of the program is to use those vaccines to try to diversify the immune response; it's not necessarily to have the closest match to exactly what is circulating today. We know that omicron variants are the most distinct from the original ancestral strain, so providing a vaccine that covers both of those allows the immune system an opportunity to establish a strong breadth of protection that we think will be important going through this winter for the program.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tunis.

Mr. Blaikie, welcome to the committee. You have the floor for the next six minutes.

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

Thank you very much, Mr. Chair.

Thank you, Mr. Tunis, for those comments.

If I understood Monsieur Garon's question, I think it's an important question because it speaks to the confidence that Canadians have. We know that it's been a difficult time in some cases with respect to trust. What we are concerned with doing around this table is trying to help build confidence in those recommendations. I took him to be asking essentially whether Health Canada has access to evidence and data that the World Health Organization is not using or whether Health Canada has the same data but different criteria for what we count as sufficient to be able to make a recommendation. We do have a curious situation in which the WHO is saying there's not enough data to make a recommendation, and we have our own national advisory council, which has done very good work throughout the pandemic, saying that they're satisfied that they do have enough evidence to make a recommendation.

Can you please help us understand the difference—whether that's a difference in the data at your disposal or it's a difference in the criteria you're using to assess the adequacy of the evidence—in terms of why we have apparently competing proclamations?

[Dr. Theresa Tam]

Mr. Chair, thank you for that question and further clarification.

I would just emphasize that we have to look at the point in time at which these different organizations are communicating. Right now it's not just Canada. The United States, the European regulatory agencies and indeed countries very similar to our own—which have access, of course, to the manufacturers' data and their own epidemiologic information—have all recommended the bivalent vaccines.

That may be something we need to consider. I really want to thank the committee for trying to bring this point out so that Canadians can understand. Health Canada, which is not here today, our regulator, has very strong safety and effectiveness criteria that they bring to bear. They do talk to the FDA, the European Medicines Agency and the United Kingdom, for example, and they exchange information very closely. So they do share the data and they have similar data in front of them.

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

Thank you.

Mr. Tunis, go ahead, please.

[Dr. Matthew Tunis]

I could add to that as well, Mr. Chair, if possible. Thank you.

We work closely with our international counterparts and we know that many countries, as well as the WHO, have an advisory committee of experts similar to Canada's. We often see these advisory committees having common threads of understanding, as Dr. Tam mentioned, but we also see areas of deviation. What's important to understand and remember is that every country has a unique context and a unique environment. In the case of the WHO, they are in fact speaking to the entire global context.

In Canada, NACI is taking the Canadian information and evidence, the Canadian supply context and the available products into consideration. The WHO has certainly not recommended against bivalent products; it is recommending that those can be included as part of the booster suite, but it is not making a distinction or a preference among the different products, whereas in Canada, based on the supply context, the availability of the products and NACI's expert assessment, the recommendation was in fact that the bivalent products could be preferred.

I think an important level-setting piece of information is that all of these countries are recommending booster programs. It's now a question of which product among the suite of available products might give the best edge, and there will be different expert assessments again as the evidence continues to evolve on that.

At the end of the day, WHO, NACI and other countries are recommending that boosters should be used as part of a fall framework, as part of a preparedness against the winter season and the strains to come. We are seeing the bivalents being recommended and used quite broadly in Canada, Germany and the U.S. There has been a preferential direction towards bivalents. I think there is actually not a large gap between the positions of NACI and the WHO on this.

Thank you.

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

Thank you very much for that answer. I think that was quite helpful.

What I'm hearing is that Canadian organizations are paying attention to what other international bodies are doing, but also have specific, if not privileged, information relevant to the Canadian context. When Canadians are asking themselves which body they should go to first for the best advice for themselves and their families, it's the organizations based here in Canada that have experts who are paying attention to all of the many types of statements being made on the international stage, and then adding that Canadian-specific information to issue in particular recommendations for Canadians. I thank you very much for making that case clearly.

Of course, public trust factors into that. We want people to have the maximum amount of trust in our Canadian institutions they can. One thing coming out of the SARS experience was an emphasis on the need for an independent evaluation of how the Canadian government and Canadian officials performed in that context. That's something that hasn't happened yet here in Canada in respect of the COVID-19 experience.

I'm wondering if you can speak to the importance of having a public inquiry, independent advice, not necessarily because the findings are going to be different than Health Canada's own internal processes, but because I think it helps Canadians enjoy more confidence in those findings when they know they're coming from an independent source. Could you speak to the value of that independent investigation and give some thought or express some views about the timing of such an investigation? I think that would be welcome.

Thank you.

[The Chair, Liberal, Sean Casey]

To the witnesses, Mr. Blaikie has well exceeded his time, but we would be interested in a brief response if that's possible.

Thank you.

[Dr. Theresa Tam]

Thank you, Mr. Chair.

I can't comment on the specifics of any such reviews and inquiries. All I have to say is that we've just been through the biggest pandemic of the current era. It is very important to take note of lessons learned and be as objective as we can. The inputs from a variety of experts on what went well, as well as what could be improved, are important to set us up well for our response going into the future, given that pandemics will occur again.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

We have Mrs. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

Thank you to all the witnesses for attending today virtually. It would be lovely to see your smiling faces here in person, as I do believe it often adds to the richness of the back-and-forth dialogue to have our witnesses here in person, but alas I won't harp on that.

I'm not sure if you follow what goes on at the health committee, but I've brought up on numerous occasions—as have some of my other colleagues—concerns around the lack of pediatric formulations of over-the-counter drugs, specifically infants' Tylenol, Motrin and Advil.

This is especially concerning as we're approaching the cold and flu season, when parents are going to need more of this. What would you recommend to parents going forward, as we approach the cold and flu season in this COVID-19 era, when there is no over-the-counter pain medication available?

[Dr. Theresa Tam]

Mr. Chair, the supply of these medications isn't really in the purview of the Public Health Agency. I will say that, of course, prevention is key, and that getting up to date with vaccinations is one way of preventing certain respiratory infections.

Certainly there are other ways, for example, to soothe children and reduce fevers. That kind of information should be made readily available, including through pediatricians and the Canadian Paediatric Society. I think there's work done by Health Canada and others in the federal departments to link up with pharmacists, pediatricians and others to address the situation, and also to provide parents with sound advice.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you. I don't think it's necessarily going to provide a lot of comfort to parents to tell them that there are other ways they could deal with their child's fever. They're probably going to end up taking them to the emergency room at two in the morning rather than providing them with the pediatric pain medication that would just solve the problem.

I think this is one of the big issues in which I see a major disconnect between the advice we get from the Public Health Agency of Canada and what we hear on the ground.

I represent a large rural riding in northern Alberta. They see your press conferences, and they don't feel heard. They don't feel like you have been on the ground in many rural and remote communities to actually understand some of the day-to-day experiences, so I would encourage you.... Have you gone outside of Ottawa to hear from people directly, to see what things are looking like on the ground in Canada?

[Dr. Theresa Tam]

That's an important point, and, for sure, we have different roles and responsibilities between the federal, provincial, territorial and local governments, but it is important to hear from communities, so that's a really good suggestion.

All I am saying is that I know that my colleagues in Health Canada, and indeed the minister, have been working very diligently to look at the supply situation for the medications that you've just talked about. It's just that it's not the day-to-day responsibility of the Public Health Agency, and I want you to get the best information from the right department. We can certainly reach back to our Health Canada colleagues on that front.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

From that answer, can I ascertain that PHAC and you have not travelled to see what the state of the COVID response is outside of Ontario?

[Dr. Theresa Tam]

Of course I always work with the other chief medical officers, and it is their responsibility as well for their own communities, but we also have regional offices of the Public Health Agency that are placed across Canada. They have been our eyes and ears on the ground to the local situation, and indeed, to link with local jurisdictions in terms of public health.

We work very closely, of course, with Indigenous Services Canada because one of the key federal populations that we have to listen very carefully to is the indigenous peoples—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Not to interrupt, but it is just a yes-or-no question. Have you travelled outside of Ontario to see what the COVID situation is on the ground?

[Dr. Theresa Tam]

I have been fortunate to be able to go to Montreal, Quebec, but also to Vancouver. However, no, I have not travelled extensively, but as I said, we have many staff who are on the ground.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

Next is Mr. van Koeverden, please, for five minutes.