Evidence of meeting #35 for Health in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was vaccine.
A recording is available from Parliament.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
If I have time, I'd like to pivot to Dr. Tunis. Thank you for being here today.
My question is around the ongoing evaluation of vaccine effectiveness. As I understand it, for the new bivalent vaccines, we don't have as yet the clinical effectiveness data. I'm sure that's expected in the future. Maybe you could comment on the antibody response data versus expected clinical effectiveness data, and how that might add to your recommendations.
Executive Secretary, National Advisory Committee on Immunization, Public Health Agency of Canada
As the member has pointed out, the bivalent vaccines, which have been recently authorized and recommended in Canada—from both Pfizer and Moderna—have been authorized based on antibody levels and neutralizing antibody titres.
That's not the same as clinical effectiveness, where we see in the real world how many cases of COVID-19 or particularly how many severe disease cases, hospitalizations and deaths are being prevented. However, we have seen in general, throughout the pandemic, a fairly strong correlation with neutralizing antibodies: Higher levels of antibodies can be protective against some of these outcomes. We don't have a correlative protection, so we don't know exactly what line in the sand you can draw to say you will prevent x number of cases with x level of antibodies, but there does seem to be a general trend of correlation that we are observing.
Those new vaccines have been authorized and recommended based on higher levels of antibodies against omicron strains, which is a good thing. As Dr. Tam noted in some of her opening responses, the direction so far that we're seeing in the variant environment is continuing toward omicron subvariants, so there's an advantage to having the immune system primed or boosted with omicron-containing vaccines.
While we see higher antibody levels in these products, we don't yet have the real-world evidence, and there's generally been a pattern throughout the pandemic of how this evidence comes to bear. We have research partners in provinces and territories in Canada who conduct vaccine effectiveness studies and monitoring, or the surveillance of how the vaccines perform once they're deployed. We know that the U.S. and the U.K. also have strongly based research groups that can issue those kinds of data and those estimates.
The general trend we've seen through the pandemic is that once the vaccines are deployed, somewhere between two and six months after the deployment we start seeing the real-world effectiveness data come in. We're on that track now that the bivalent vaccines are rolling out in Canada. We know that many millions of doses have been used in the U.S. as well, and also in the United Kingdom, so we do expect to see those vaccine effectiveness estimates start coming in.
I will note that the entire vaccine effectiveness monitoring landscape is becoming increasingly complex, because we now have multiple different vaccine products that people have had in terms of boosters. They've had different vaccine experiences through their primary series, and also we have different levels of infection from either pre-omicron variants or omicron variants. We have a very different mix of population in terms of who's been infected and who's had x number of boosters, so to actually try to calculate vaccine effectiveness is becoming harder and harder. It's probably not going to be a simple answer that it's x per cent, because it has to take into account whether it will be x per cent for people who have been previously infected or x per cent for people who have had x number of boosters. It's becoming more and more complex, but we are well established to be able to monitor this and see research estimates coming in over the coming months.
I will also note that this is very similar to how we conduct influenza vaccine programs, where we, as Dr. Tam noted, have strain substitutions and launch new products in the fall. Then the effectiveness monitoring comes in months after, and we see how the products perform in the real world. We're making some early assumptions based on the way the vaccines have been studied in the trials, and then we're deploying them and following up with the real-world effectiveness, which can feed back into policies and guidelines that can be updated, so it becomes a research or a knowledge cycle.
Thank you.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Tunis.
Next we have Mr. Hoback, please, for five minutes.
October 18th, 2022 / 12:15 p.m.
Conservative
Randy Hoback Conservative Prince Albert, SK
Thank you, Mr. Chair.
It's nice to be part of this committee for the day.
I guess where I'm going to go is on the credibility, Dr. Tam. One of the concerns I have coming out of the riding of Prince Albert is a lack of credibility now in our government institutions all the way around, and I think it shows automatically when you start to look at the people taking booster shots, for example. The numbers are substantially lower now than they were, let's say, this spring. I think part of that comes back to some of the things that have gone on over this last year.
For example, in Saskatchewan, Dr. Shahab would make a recommendation, and we'd remove masks. I'd fly to Ottawa, and we'd be fully masked. Canadians would say, “How come the science in Saskatchewan says one thing, yet the science in Ottawa says something different?” How do you build credibility back in those scenarios going forward?
What really scares me is that we don't have credibility in the organizations now, and if there was a bad virus that's really bad, where you needed to bring forward the lockdowns and things like we had to do, supposedly, at the start of COVID, Canadians wouldn't listen to you. They would say, “Never. We're never doing this again. We don't trust you. We're not listening to you.” We'd see then the massive deaths that would be the result of that because we don't have credibility or the trust of Canadians.
What is your plan to build back that trust?
Chief Public Health Officer, Public Health Agency of Canada
This is really important, and this is why we must come together, work together, to earn that trust and keep it up. The outcome for Canada has been relatively good, but I—
Conservative
Randy Hoback Conservative Prince Albert, SK
Excuse me. I'm going to interrupt you here. The outcome—
Liberal
The Chair Liberal Sean Casey
You asked a question that lasted longer than a minute, and you interrupted her 15 seconds into her answer. She's entitled to at least as much time—
Liberal
The Chair Liberal Sean Casey
—to answer the question as you used to pose the question.
Go ahead, Dr. Tam.
Chief Public Health Officer, Public Health Agency of Canada
Between myself and my other chief medical officers, we have regular interactions. They voiced the fact that, while we're in the same pandemic, everyone is in a different context. We do work with similar data, so mask use, for example, is very important if the mask is properly constructed and well fitted. Where it differs is how those policies have been applied, where the requirements have been applied versus recommendations. We've seen that undergoing evolution over time, but it's the same recommendation in terms of the importance of layering on those protections.
It also depends on the epidemiologic activity in the community or the province. That has to be taken into account, so listening to your local medical officers is very important.
However, it is difficult in a country as big and diverse as Canada, and we are not recommending a complete blanket approach to everything. That can sometimes undermine communication and trust, but we do have to recognize that there are differences.
Conservative
Randy Hoback Conservative Prince Albert, SK
The next level.... Being in Saskatchewan, we'd look across to the U.S. and into Montana, North Dakota, and South Dakota. When we were doing our lockdowns, we were watching what was going on there. We were saying, “Okay, their science is saying something totally different than our science.”
We see even today that the ArriveCAN app was finally taken away. I do want to know what your involvement was in the creation of that app. That's one question.
We still have differentials in North America on what is allowed and whether people who are vaccinated, or not vaccinated, can cross the border. For example, anybody can come into Canada now, but going to the U.S. if you're not vaccinated.... I hear different stories. If you're at the border, a lot of the border officers will ask you, but some of them won't. It is different.
That difference creates confusion, so what is the communication between us and the U.S., for example, in this scenario? What is the recognition of science from other areas, as we go into making our decisions?
When you make that decision, I assume you make recommendations to the Prime Minister, and he makes the decision. How do you square things when the Prime Minister goes to a committee that isn't made up of science to make the final decision over what you recommended?
Chief Public Health Officer, Public Health Agency of Canada
We do maintain close communication with the United States and, no, I'm certainly not responsible for the ArriveCAN application itself. We can refer you to our colleagues at CBSA, but our VP—
Chief Public Health Officer, Public Health Agency of Canada
—who is in charge of borders is on our panel today if we need to refer to her.
Let me just remind you that the United States had three times the human deaths per 100,000 population than Canada, so we did do things differently, and have been doing things differently. Our outcomes are actually quite different if you just compare mortality rates, not to mention hospitalizations and other impacts.
Yes, you can look across the border, but we actually did better in the Canadian context by doing things a bit differently.
Conservative
Randy Hoback Conservative Prince Albert, SK
I'm not going to argue with you, Dr. Tam. I actually agree with you on that.
However, we did notice that the Americans could react a lot more quickly in their hospital scenarios. They could actually add intensive care beds. They could add the staff. Here in Canada, I think Alberta threw a billion dollars at it in June, and by September-October, it still didn't have one more intensive care bed. It comes back to, as you said, our health care system being so taxed that there's no grace, or buffer zone, for something like COVID, or something that comes along in the future.
It's even worse now, because we've postponed all these elective surgeries on knees, hips, and shoulders, and we're trying to get them back into the system. If we were to have another virus, or even COVID resurrected into a very deadly virus, we wouldn't have capacity, and nobody seems to want to address that.
Conservative
Matt Jeneroux Conservative Edmonton Riverbend, AB
Mr. Chair, I have just a quick point of order, plus a point of clarification.
From your perspective—again, I'm new on the committee—you cut off my colleague at the beginning. You said the reason was that his time had to accurately reflect the witness's time. There have been times when I've been on a committee where people have interrupted and asked for a simple yes-or-no answer. They've gotten that, and they were able to move on.
I'm curious, and I imagine our whips will probably have this discussion, but before it gets to that point, could you clarify your ruling, so we have it at least on our side? If the situation comes up again, we'd at least know your perspective.
Liberal
The Chair Liberal Sean Casey
In fairness to the people posing the questions and the people answering the questions, the rule of thumb is that the witness be allowed the same amount of time to answer the question as the person who has posed it. Therefore, when Mr. Hoback took over a minute to present his question and then 15 seconds into her answer he interrupted her, I intervened.
By the same token, if a member asks a short question, for example, and a minister drones on, it's entirely appropriate for the MP to interrupt the witness. If it's a short question, they're allowed to interrupt after a reasonable amount of time. That's been the rule of thumb, as I have applied it, in terms of chairing this meeting. It's how I've been chairing this committee consistently from the outset.
That's what happened.
Mr. Hoback, go ahead.
Conservative
Randy Hoback Conservative Prince Albert, SK
In regard to that, I have chaired committees before, and there are times when you need a minute to preface your question, but the answer requires only 15 seconds. When you see a witness not doing that, then you have the right to interrupt and say, okay, I need to ask...because you have only five minutes. It is my only time throughout the next six weeks to ask these questions, so if I feel that the witness either isn't answering the question or has answered it and I want to move on, then I have the right to interrupt.
Rules of thumb are great, but the reality is that it is not a functioning actual standing order within the committees in that regard. It is my time. If I decide to interrupt, I'd expect the chair to respect that and to respect my maturity. The reason I'm interrupting has very important context in terms of what I'm trying to do to get information for this committee. By interrupting, you've broken the flow of my questions. You've taken away my time and my ability to actually get to the bottom of some serious questions for this panel, because of how you did it.
I appreciate the rule of thumb, but in this case I think it was totally inappropriate.
Liberal
The Chair Liberal Sean Casey
You always have the right to challenge the chair.
Mr. Jowhari, go ahead, please.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Mr. Chair.
Thank you to the witnesses for coming today.
Dr. Tam, most of my questions are going to go to you.
I've heard various versions of “the pandemic is over”, or the emergency part of the pandemic is over. But the pandemic continues. Therefore, there is, naturally, uncertainty associated with that level of communication. It was recommended that we get our booster vaccine. I've done my primary as well as the two boosters. I'm looking forward to getting my bivalent vaccine soon.
We talked about the outcome, and that's the best way of being able to measure our success. Had we not followed the guidelines that were set, in combination with consultation with our scientists and data, as well as, let's say, the government policies, where would we be?
We know that today we are at 45,689 individuals who have paid the ultimate sacrifice. Where would we be if we hadn't followed those? That's really the end outcome. Can you shed light on that?
Chief Public Health Officer, Public Health Agency of Canada
This is a really important point, and one on which public health needs to do a better job. Describing what did not happen and what is prevented is not an easy task.
The Public Health Agency scientists did provide a publication recently on what we call “counterfactual scenarios”, where we looked at the impact of vaccination and the collective response of public health measures in Canada. If we had done absolutely nothing.... And that was not going to happen. But just imagine that you did not have any vaccines, that you did not follow any public health measures. You would have had, of course, most of the population being cases, up to 34 million cases, two million hospitalizations—that's stress on your hospital systems—and up to 800,000 deaths.
Of course, there are many in-between scenarios, whether we look at the application of public health measures without the vaccine or the application of vaccines without public health measures. The bottom line is that you actually needed them both, particularly during different times of the pandemic when there wasn't a vaccine and then when there was a vaccine.
This is why I say that we have to remember the impacts of this pandemic. Relative to other G7 and peer countries, we did relatively well—that is, compared with the death rates in the United States, the United Kingdom and other similar countries. We have to learn and be humble. We have to learn from other countries that have done better than us, as well.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Dr. Tam.
We lost over 45,000 Canadians. Had we not followed the rules or the established guidelines, we potentially could have lost up to 800,000. That, to me, is simple and Canadians can understand.
You talked about communication. One of the comments you made is that we have to change the way we communicate uncertainty. Again, school is back. We are all going indoors. Most of us have had at least one booster shot. Uncertainty is coming. How should we communicate as a government or agency? How should our doctors, our pharmacists, our media or social media communicate this during this uncertain time?