Health Committee on Oct. 18th, 2022

[The Chair, Liberal, Sean Casey]

Welcome to meeting number 35 of the House of Commons Standing Committee on Health.

Today we meet for two hours with witnesses on our study of the emergency situation facing Canadians in light of the COVID-19 pandemic.

We do have some preliminary business that we should deal with right away. As a result of the motion that was just passed in the House, we are now without our first vice-chair, and it is customary to fill that vacancy.

I trust all of the campaigning is complete, the arms have been twisted, the deals have been made, and this will all proceed expeditiously.

I now hand it over to the clerk to preside over the election of the first vice-chair.

[The Clerk of the Committee, Mr. Patrick Williams]

I must inform members that the clerk of the committee can only receive motions for the election of the vice-chair. The clerk cannot receive other types of motions, entertain points of order, or participate in debate.

Pursuant to Standing Order 106(2), the first vice-chair must be a member of the official opposition. I am now prepared to receive motions for the first vice-chair.

Mrs. Goodridge.

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

I would like to nominate Dr. Stephen Ellis to be the first vice-chair.

[The Clerk]

It has been moved by Mrs. Goodridge that Mr. Ellis be elected as the first vice-chair of the committee.

Are there any further motions?

Is it the pleasure of the committee to adopt the motion?

(Motion agreed to)

I declare the motion carried, and Mr. Ellis duly elected as the first vice-chair of the committee.

[Some hon. members]

Hear, hear!

[The Chair, Liberal, Sean Casey]

Congratulations, Dr. Ellis.

[Majid Jowhari, Liberal, Richmond Hill, ON]

It comes with privileges and rights. Let's make sure the privileges are not rights.

[The Chair, Liberal, Sean Casey]

That was a very efficient and effective campaign. In keeping with our further discussion, I'll do my best to look after myself, so that your vice-chair's duties won't be too onerous.

Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022. All of the witnesses we have before us today are familiar with the processes associated with hybrid meetings. Screenshots, or taking photos of your screen, are not permitted. The proceedings will be made available on the House of Commons website.

In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

I will now welcome our witnesses who are with us this afternoon. From the Public Health Agency of Canada, we have Dr. Theresa Tam, chief public health officer; Dr. Howard Njoo, deputy chief public health officer; Stephen Bent, vice-president, COVID-19 vaccine rollout task force; Jennifer Lutfallah, vice-president, health security and regional operations branch; Cindy Evans, vice-president, emergency management branch. From the National Advisory Committee on Immunization, we have Matthew Tunis, executive secretary.

Thank you all for taking the time to appear today.

I understand Dr. Tam will be giving the opening statement.

Dr. Tam, you have the floor. Welcome back.

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Mr. Chair, thank you very much for once again inviting the Public Health Agency of Canada to provide an update on the COVID-19 situation in Canada.

I would like to acknowledge that I am speaking to you from Ottawa, the traditional unceded territory of the Algonquin Anishinabe people.

As per the public update that I gave on October 7, virus transmission is occurring across the country with regional variation. The latest data up to October 8 shows that COVID‑19 disease indicators, such as weekly case counts and lab test positivity, are stable compared to the previous week. At the same time, hospitalizations are elevated or increasing in some areas, which could be an early sign of fall resurgence.

As gatherings and activities begin to move indoors because of the colder weather, COVID‑19 and other respiratory infections can spread more easily. While the risks of exposure may be increasing with more virus circulating, for many, immunity from vaccination or prior infection may be waning.

This is why the National Advisory Committee on Immunization, NACI, recommends getting a COVID-19 booster dose six months after your last COVID-19 vaccine dose, or your last infection. It is important that we all stay up to date with our vaccination to maintain our protection.

In the coming weeks, seasonal influenza vaccines will be rolled out across Canada. It is good to know that influenza vaccines can be given at the same time as COVID-19 vaccines to people over five years of age.

For many people across Canada, it has been six or more months since their last vaccine dose or infection. As a result, overall population immunity may be falling and leaving us all less protected.

Only 18% of those eligible are up to date with their COVID-19 vaccination in terms of having completed their primary series or received a booster dose within the past six months, with younger Canadians reporting lower coverage relative to older-age adults.

We now have two bivalent COVID-19 vaccine booster formulations that are good options for improving protection in people aged 12 years or older. As of October 9, over 5% of eligible Canadians have received a bivalent vaccine.

Both bivalent vaccine formulations target the original virus strain and the highly infectious omicron variant. Likewise, both bivalent vaccines are expected to boost immunity against omicron variants and broaden the repertoire of our immune response to the SARS-CoV-2 virus.

Although there is a temptation to believe that infection from the current circulating variant is not so bad, it is important to remember that infection also means continued transmission of the virus, and carries with it the risk of developing post-COVID-19 condition, or long COVID. There is scientific evidence suggesting that receiving at least two doses of a COVID-19 vaccine before infection reduces the risk of post-COVID-19 condition.

The World Health Organization recently indicated that we have never been in a better position to end the pandemic, but while the end is in sight, we are not there yet.

While transitioning towards a longer-term, more sustainable approach to the pandemic, we will continue to work in collaboration with our provincial and territorial partners, indigenous communities, as well as key stakeholders.

During the transition, we will continue to monitor for and prepare for worst-case scenarios, such as the emergence of more transmissible, immune escape or more virulent variants.

The Public Health Agency of Canada's established pan-Canadian network for a wastewater surveillance program enables efficient monitoring of a community for early detection and major trends in virus activity. Clinical and wastewater genomics continue to inform public health measures, predict and monitor the circulation of COVID‑19 variants in community and institutional settings, and develop short-term modelling forecasts.

The agency will continue to disseminate evidence and produce guidance to inform decision-making about response measures, with consideration given to the most recent evidence, the current epidemiological situation and other key factors such as health care system capacity. The agency will continue to communicate on the evolving situation to Canadians, recognizing that uncertainties remain.

In addition, the agency will support public confidence for vaccines and personal protective practices that empower Canadians to take individual and collective responsibility. The priority will continue to be protecting the health and safety of Canadians, and our path forward will continue to be based on the best available science and evidence.

Thank you. Meegwetch.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Tam.

We're now going to proceed with rounds of questions, beginning with the newly-minted vice-chair of the committee, Dr. Ellis, for six minutes, please.

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

Thank you, Mr. Chair.

Thank you to the rest of the committee for their vociferous, yet traditional confidence in electing me the vice-chair. I really appreciate it, of course.

Thank you very much to the members of PHAC and NACI, and others who have come here today.

Certainly, the anxiety level with respect to COVID in the minds of Canadians has subsided, but of course the ever-burgeoning threat of things moving indoors and the increased risk is there.

Along that line of questioning, perhaps I'll go back, Dr. Tam, to something we've talked about multiple times before. Hopefully this time you'll be able to shed some light on this for all Canadians. If we are talking about increasing measures with respect to perhaps access and mask wearing, etc., I believe that Canadians want to know which metrics or benchmarks the Public Health Agency of Canada will be using to make those decisions.

I realize that previously you have told this committee multiple times that it's much too complicated for us to understand. I take that with great umbrage, of course, but would appreciate your comments with respect to that today.

[Dr. Theresa Tam]

Mr. Chair, thank you for the question.

Of course, many of these measures are taken at the local and provincial levels, as well, not just by the federal government. The current status of public health measures is decided more at that local level.

I think it's a combination of different assessments and metrics. First of all, we have to assess the virus—the variants that are currently circulating and their characteristics. That includes how transmissible they might be, whether they escape immunity developed through prior vaccinations or infections, and their virulence. How severe are those virus variants? Of course, there's ongoing study of host and population-level immunity, such as through the serosurveys undertaken by the COVID-19 Immunity Task Force.

The capacity of the health care system is very important. As people have seen, when hospitals, emergency rooms and other places are stressed, that needs to be taken into account in terms of whether, for example, mask wearing would help reduce some of that spread and impact on the health system. If any public health measures are put into place, they are there to buy time, as well. During any such time periods, provinces and all levels of government have to take action, including adjusting any of the recommendations and guidance required. It's also a balance between reducing transmission and its impacts and, of course, the potential negative effects of some of these measures on society.

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

Thank you, Dr. Tam. I appreciate that answer. It's certainly different from before, and I hope this can improve our working relationship as we go forward. I don't think it's related to my new title, but maybe it is.

On behalf of all Canadians, in the next minute and a half, perhaps I'll ask you to speak, Dr. Tam, about variants of concern.

[Dr. Theresa Tam]

I think it is great that, during the pandemic, more capacity has been provided for us to monitor genomics and other characteristics of variants of concern. The Public Health Agency of Canada and, indeed, our National Microbiology Laboratory, as well as provincial, territorial and global lab works, have been monitoring the ongoing evolution of the SARS-CoV-2 virus.

The trajectory of viral evolution has changed over time. This is quite interesting. The earlier variants have multiple and often very divergent evolutionary pathways, seeing as there were no vaccines, therapeutics or broad-based population immunity to constrain the range of the mutations. More recently, however, multiple lineages descending from the omicron variant—that very transmissible variant—have begun to develop multiple identical mutations, a phenomenon we're calling “evolutionary convergence”. We have to learn more about that. You may have seen or heard about a variety of these variants, such as BA.2.75, BA.2.75.2, BA.1.1 and BA.4.6. Multitudes of BA.5 descendants have these convergent evolutionary mutations.

The very important thing about monitoring these mutations is that, when there's broad population immunity, it seems to put pressure on the virus to find advantages, such as escaping our existing immunity from infection or vaccines. This broad range of omicron descendants is now being carefully monitored.

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

Other than that, there certainly are, potentially, other variants coming down the pipeline, of course. Communicating with other countries is essential.

Are there any other specific scary variants of concern out there, Dr. Tam, at the current time?

[Dr. Theresa Tam]

At the current time, there are descendants of omicron variants and subvariants, but we haven't detected any very extraordinary appearances, as yet. That is a scenario for which we're planning ahead. For example, a very distinct immune escape, where vaccines or treatments don't work and it causes severe illness, is one of the worst-case scenarios. We haven't detected one of those yet, but we need to be prepared for the potential.

[The Chair, Liberal, Sean Casey]

Thank you Dr. Tam.

Next we have Dr. Powlowski, please, for six minutes.

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

Thank you.

I would like to welcome Dr. Ellis as the new vice-chair of the health committee.

I think things are looking really good with respect to COVID. Usually when school returns, that's the time for a real rapid spread of disease, and we really haven't seen that, so I find that really encouraging.

Prior to this meeting, I looked up what is of concern right now. I understand that there was a Swedish study recently looking at the BA.2.75.2 variant, which there is some concern about, even though the variants that are common in Canada right now are the BA.5 and the BA.4.

For the BA.2.75.2, which is apparently a lot worse than those without the “2” on the end, studies apparently show that it seems to escape, that it is no longer sensitive to the antibodies that are out there as a result of either the vaccine or previous infection. Now, I'm not sure what that means. Apparently, in India this has been around for at least a month. It's present in 40 different countries. I saw news reports of it in India a month ago, and yet there don't seem to be any reports of large numbers of people being hospitalized or of deaths in India.

Can you tell me what you know about that variant? There does seem to be concern about the effectiveness of the vaccine and the treatments against that variant.

[Dr. Theresa Tam]

Mr. Chair, thank you to the member for that question.

On BA.2.75, indeed, BA.2.75.2 is the specific sublineage that we're monitoring. It's part of the group that I mentioned in response to the last question. The BA.2.75 and its sublineages currently represent 1.1% of the sequences detected in mid-September. It has stalled recently in Canada.

However, it still needs to be monitored, because BA.2.75.2 has been growing considerably faster than other BA.2.75 sublineages that we're monitoring. The vast majority of sequences in Canada at this point are still BA.5, but BA.5 has many different variations that we are monitoring, as I've said in my last report. The member is correct, in that one of the concerns is that is it able to evade potential prior immunity or monoclonal antibody treatment.

The good news is that we do have these bivalent vaccines. They are now on board. All of the vaccines so far, actually, have good impacts on severe outcomes.

As well, we have treatments like Paxlovid. That is not a monoclonal antibody treatment, and it is available for those at the highest risk.

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

Now, from your response, the BA.2.75.2 is 1% of the cases in Canada and hasn't been increasing. Do I have that right?

[Dr. Theresa Tam]

Yes, its growth has been observed, but it's stalled. It's slowing.

On the contrary, BQ.1.1—I think some news media have been covering that sublineage, which is a descendant of BA.5—has a faster growth estimate at this point. It represents only 0.6% of our current sequencing that was last reported, but because of the rapid increase and acceleration—for example, in European countries—that one deserves close attention.

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

A number of people, including my daughter.... She asked me this yesterday. She said, “Dad, should I get the bivalent vaccine?” Can you make a case for the bivalent vaccine versus the previous vaccine?

[Dr. Theresa Tam]

Yes.

The National Advisory Committee on Immunization—and Dr. Matthew Tunis is here with us—made a recommendation to preferentially use the bivalent vaccine, both Moderna and Pfizer now that we have them, because it contains both the original virus strain and the omicron variant strain. That helps not only to boost your antibody level when you get the booster—if you haven't had it in the last six months, go get one—but to broaden the repertoire of your immune response.

It does more than just boost levels of antibodies. The way that these bivalent vaccines are constructed, we believe it will increase the repertoire of the immune response itself.

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

One of the frequent criticisms we initially heard about the messenger RNA vaccines was that we didn't have much experience with them and they were new. That argument is getting a little tired, in that we've been using them for over two years and, seemingly, we haven't seen any great rise in adverse effects as a result of the vaccines.

I think a lot of people, especially people with kids, and I have a bunch of kids.... When you're talking about the combination vaccine, this is a new vaccine, so what can you say to reassure us that this combination vaccine is as safe as the original vaccine?

[Dr. Theresa Tam]

Health Canada, of course, has a well-established process in evaluating both the safety and the immunogenicity of the vaccines. After any vaccine is launched, we will have post-implementation studies, especially on safety, but also on effectiveness.

As you've indicated, millions and millions of doses of these vaccines have been utilized globally. Just because we are adjusting one of the strains, that doesn't mean that any of the other processes would change. The manufacturing process and the way the vaccine is made have been assessed as usual.

One of the best analogies I could make is that it's a bit like changing influenza strains and updating them every year. A similar kind of concept is being used by the regulator. We know a lot about these mRNA vaccines and their safety. We're just swapping out and updating the strain itself.