I call this meeting to order.
Welcome, everyone, to meeting number 23 of the House of Commons Standing Committee on Health. Pursuant to the orders of reference of April 11 and April 20, 2020, the committee is meeting for the purpose of receiving evidence concerning matters related to the government's response to the COVID-19 pandemic.
Firstly, in order to facilitate the work of our interpreters and ensure an orderly meeting, I would like to outline a few rules to follow. The interpretation in this video conference will work very much like in a regular committee meeting. You have the choice at the bottom of your screen of either floor, English or French. Please speak slowly and clearly and hold your microphone in front of your mouth, as directed during the sound check. If you will be speaking in both official languages, please ensure that you switch to the language that you will be speaking on the translation icon. That will help the interpreters and people listening to the feed, and also allows for better sound quality for interpretation.
Before speaking, please wait until I recognize you by name. When you are ready to speak, click on the microphone icon to activate your mike. Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. I'll remind you that all comments by members and witnesses should be addressed through the chair.
Should any technical challenges arise, please advise the chair or the clerk immediately and the technical team will work to resolve it. If necessary, we will suspend while that happens.
Before we get started, can everyone click on their screen, on the top right-hand corner and ensure they are on gallery view. With this view everyone should be able to see all of the participants in a grid-like fashion. This will ensure that all video participants can see one another.
I'd like to welcome our witnesses now.
Each witness group will have 10 minutes for an opening statement, followed by the usual rounds of questions from members. As individuals, although appearing together, we have, from McMaster University, Dr. Gerry Wright, director of the Michael G. DeGroote Institute for Infectious Disease Research and David Braley Centre for Antibiotic Discovery; and Dr. Karen Mossman, acting vice-president, research. We also have, as individuals, from the Université de Montréal, Dr. Caroline Quach-Thanh, full professor, department of microbiology, infectious diseases and immunology, faculty of medicine, and medical microbiologist and epidemiologist, CHU Sainte-Justine; and Dr. Cécile Tremblay, professor of microbiology, immunology and infectious diseases.
Welcome, and thank you all for sharing your time with us today. We will begin with Dr. Wright and Dr. Mossman. You have 10 minutes between the two of you. Please go ahead.
Thank you, Mr. Chair. I would like to thank you all for inviting my colleague and me to appear today to discuss Canada's response to COVID-19. My name is Dr. Karen Mossman and I am the acting vice-president, research, at McMaster University. I am also a professor in pathology and molecular medicine, and a virologist by training.
Very early on, my team was involved in isolating SARS-CoV-2, the agent responsible for the outbreak of COVID-19. Isolating and propagating the virus has enabled researchers across Canada to better understand the virus and work on potential solutions.
At McMaster University, our researchers pivoted very quickly to respond to the COVID-19 pandemic. This includes working on the development of home test kits, leading a national trial for plasma transfusion and leading a trial on anti-coronavirus therapy. A great deal of work is being done across the university to innovate respiratory ventilators and N95 masks. Thanks to funding from the CIHR, my own lab is studying SARS-CoV-2 pathogenesis in human and bat cells.
The university is also doing its part as a member of the community. We donated our stock of personal protective equipment to our community hospital, and our residences are currently being used to host medical residents as needed.
Many of our researchers are at the forefront of the global coronavirus research. This pandemic is the very reason that we established our Institute for Infectious Disease Research. We have built infrastructure to respond to crises and outbreaks like COVID-19. One of our researchers with the institute, Dr. Dawn Bowdish, is currently looking at how the immune system responds to infection and will provide insight for the prevention and management of COVID-19 which may lead to potential treatments.
I will now pass it over to my colleague, Dr. Gerry Wright, who is the director of our Institute for Infectious Disease Research and who can speak more to the work that is being done there.
Thank you very much for the invitation to speak here.
The COVID-19 pandemic is revealing what we in the field have known for decades—that is, despite the tremendous advances in medicine over the past century, we remain highly vulnerable to infectious diseases. We knew this because of the lessons of other pandemics, epidemics and outbreaks that we experienced in recent memory. These include HIV/AIDS, Ebola, the first SARS epidemic, MERS, H1N1 influenza and now COVID-19.
My own research is focused primarily on addressing the other pandemic we are simultaneously experiencing, that of antibiotic resistance, or AMR. AMR is slower-moving than COVID-19, but it has the potential to be even more deadly and create greater economic burdens than the current crisis. I will return to AMR in more detail later, but first I want to frame my remarks around what I see as the current reality.
Despite these past experiences with epidemics and pandemics, we must be honest and recognize that we have, time and time again, failed to learn that we must continuously support research and development in infectious diseases to be prepared for the next problem. To paraphrase Donald Rumsfeld, in infectious disease there are the “known knowns”, the things that we know are a problem, like AMR. There are the “known unknowns”, the things that we know will happen but can't easily predict, like a new viral pandemic such as the one we're experiencing. Then there are the “unknown unknowns”, the things that we don't even see coming, like the emergence of prion infections like mad cow disease, which took us all by surprise.
The only way we can prepare for these eventualities—that are, eventually, going to occur—is to support a robust, nimble and multidisciplinary community of infectious disease researchers in Canada.
The parallel to fire departments is often made. We as a society support the purchase of fire trucks, the very best and reliable equipment, and employ well-trained firefighters, because we have learned to be prepared for fires. We value this protection. Even though we hope that as individuals we never need it, if we do, then we sure are happy that we invested in it.
To be prepared for the next challenges in infectious disease, we need to invest in and develop a vibrant community of scientists, clinicians, engineers and social scientists who will dedicate their careers to solving our current problems and the ones that we know will emerge. However, given the lack of sustained funding in this area, our best and brightest young researchers and clinicians do not see great opportunities to thrive—
Again, I apologize for the technical problem.
I was making the point that to be prepared for the next challenges in infectious diseases, we need to invest and develop a vibrant community of scientists, clinicians, engineers and social scientists who will dedicate their careers to solving our current problems and the ones that we know will emerge. However, given the lack of sustained funding in this area, our best and brightest young researchers and clinicians do not see great opportunities to thrive by studying infectious diseases. We do not have sufficient support to maintain our existing key facilities such as the biosafety level 3 labs that are so important today, let alone expand our capacity in an emergency.
I want to be clear that I'm very grateful for the funding that my team and I have received from CIHR to address the COVID-19 crisis. We're working with a great team of virologists, chemists and experts in human responses to infection to find new candidate drugs to treat COVID-19, but this is challenging, as you can imagine, in the midst of a pandemic. Had we invested in the past in programs that sought to build these teams and support them, we might have been in a position to lead the globe in this crisis. Canada can and should be leading the world in infectious disease research.
This takes me back to AMR, the other pandemic we're now experiencing, a known known. No one can argue that antibiotics haven't changed medicine, perhaps like no other group of drugs has. Antibiotics not only cure infections caused by bacteria; they have enabled much of the progress in modern medicine over the last 75 years by being there to prevent infection. For example, in major surgeries, cancer chemotherapy, organ transplants or hip and knee replacements, antibiotics are used to make sure that these procedures occur infection-free.
Imagine where we'd be without these miracle drugs. It's actually pretty easy to imagine. We'd be exactly where we are right now with SARS-CoV-2, with no therapies and all the devastation that results. Ironically, we may face even more pressure in AMR due to the current pandemic as we deploy more of these drugs to avoid secondary bacterial infections, and due to untested claims of the use of antibiotics such as azithromycin in COVID-19 therapies that put pressure on drug supply and derail antibiotic stewardship efforts.
We haven't had a new class of antibiotics since the 1980s. Since then, bacteria continue to evolve and have become resistant to, actually, all of our drugs. Paradoxically, the pharmaceutical industry does not see antibiotics as profitable, and they have systemically shut down antibiotic discovery programs over the last 15 years.
At McMaster, we're trying to buck the trend. Aided by remarkable philanthropic investments, we created the Michael G. DeGroote Institute for Infectious Disease Research and the new David Braley Centre for Antibiotic Discovery. We've built a culture of innovation and dedication to solving the most challenging infectious disease problems we face today, including AMR and now COVID-19. The team is multidisciplinary. It spans medicine, biology, chemistry, math, engineering, computer science and social science. This is essential to respond to future waves of COVID-19 and future pandemics.
In closing, I'd like to again express my gratitude for the rapid research funding programs that have been deployed to address the current pandemic and for the unity of the House in supporting these investments. I can assure you that the researchers in our teams, who I note include many young people—graduate students, medical students and post-doctoral fellows—are working day and night to solve this problem.
What I, frankly, worry about is what's next for these amazing young people. They are our firefighters, but are we prepared as a society to invest in a world-class fire department for them?
Thank you, Mr. Chair.
I want to thank the chair and the members of the Standing Committee on Health for the invitation to speak. I also want to acknowledge the work of our public health authorities. Both Dr. Tam, at the federal level, and Dr. Arruda, in Quebec, are doing unenviable work. They must all make public health decisions with imperfect data and with scientific evidence that's emerging as we go along.
I'm a pediatric microbiologist and infectologist and a clinician-researcher at CHU Sainte-Justine. I'm also a full professor at the Université de Montréal's Department of Microbiology, Infectious Diseases and Immunology. I'm a past president of the Association of Medical Microbiology and Infectious Disease Canada. I'm a member of the COVID-19 expert panel established by the chief science advisor of Canada. I'm also a member of the COVID-19 immunity task force's leadership team.
My clinical and research expertise is in infection control, from the hospital to the community, and it also extends to immunization. I want to thank the Fonds de recherche du Québec en santé for supporting this research topic from the start. What stands out in the current situation is how much infection control generally isn't seen as essential, but rather as a necessary evil.
Back in 2001, the Public Health Act already acknowledged that infectious diseases could pose a threat to public health. In 2005, in the wake of the Clostridium difficile outbreak, the Aucoin report, entitled “First do no harm...Nosocomial infections in Quebec, a major health issue, a priority,” revealed that successive budget cuts had prompted facilities to reduce resources not related to the direct care of users.
This led to a decrease in the already insufficient number of infection control professionals and a reduction in housekeeping services, which had the impact that we know. The report concluded that competent and stable infection control teams were required and that a culture of prevention needed to be developed and nurtured.
Following the report, terms of reference were established in 2006 and reviewed in 2017. This document recommended that prevention teams conduct simulations as part of their preparations for managing outbreaks of virulent or emerging pathogens. The document also recommended that facility managers create clinical and administrative teams to manage major or persistent outbreaks in order to facilitate decision-making and implement recommended measures.
In this situation, management must give the designated infection control officer and the nurse manager of the department the necessary authority and resources, including line authority to suspend activities that could put people's safety at risk.
The terms of reference also recommended adherence to ratios of infection control professionals per number of beds adapted to the various types of facilities, including residential and long-term care centres, or CHSLDs. These ratios are one of the monitoring indicators at the departmental level. It would be useful to see whether the facilities monitored these ratios in the run-up to the current pandemic.
Despite the Aucoin report's findings and the resulting terms of reference, clearly many recommendations took a back seat over the years because of a significant lack of human, financial and material resources, or because they weren't considered important enough.
Infection control expertise remains key in all health crises. It must be included in the steering and management committees of facilities and networks, which isn't always the case. The infection control officer and the nurse manager, along with the other managers, must be at the decision-making table at all times, not just in times of crisis.
Prevention expertise must be recognized in all settings. We must continue to promote the prevention role played by the officer, nurses and professionals in order to attract quality people who have the necessary leadership skills and the desire to pursue a long-term career in the field.
In addition, hygiene and health workers play a key role in infection control and must be properly recognized. Occupational health offices are also understaffed, which prevents them from conducting fit testing of N95 masks and tracking workers exposed to COVID-19 cases in a timely manner.
Everyone knows the saying “an ounce of prevention is worth a pound of cure.” Yet in Quebec, preventive medicine accounts for only about 3% of the health care budget. Infection control is no exception, and it has suffered from chronic underinvestment.
The current devastation in our seniors' residences and centres is partly the result of insufficient infection control resources in these places. Obviously, the prevention measures implemented in these places must be thoroughly reviewed. The public will only be better for it.
The current pandemic also exposed the lack of personal protective equipment, which forced the infection control advisory committees to take this factor into consideration in their recommendations.
This situation shouldn't have occurred. After the severe acute respiratory syndrome, or SARS, crisis in 2003, stocks were built up. However, some stocks don't appear to have been replenished over the years.
In addition, the inability of our industries to manufacture personal protective equipment and certain drugs locally has exposed our dependence on other economies. The necessary steps must be taken to address these shortcomings in the near future.
The growing complexity of treatment and care and the fragility of our patient population in pediatric, geriatric and neonatal care increase the risk of infection, morbidity and mortality. To protect this vulnerable population from infections, both during their hospital stay and after discharge, we need well-enforced infection control practices. In the current pandemic situation, clearly proper knowledge of prevention concepts is needed in all care settings. However, this hasn't been the case.
Despite scientific progress, infection control research is still in its infancy. Grants from the Canadian Institutes of Health Research, or CIHR, are hard to come by. Infection control projects differ from other projects. They're generally transdisciplinary projects involving the social sciences, engineering, and basic and clinical sciences.
These clinical projects, along with other prevention projects, are often less well recognized than projects with a curative focus. They don't receive proper funding. The failure to invest in learning how to change behaviours and prevent antibiotic resistance, to prevent respiratory infections in CHSLDs, or to assess the effectiveness of wearing gloves, in addition to hand hygiene, are just a few examples of the shortcomings that undermine our ability to prevent infections, including the current pandemic.
Many infection control measures and recommendations are provided empirically without solid evidence. This constitutes a major barrier in ensuring that medical personnel take ownership of the recommendations. Prevention measures must be assessed. However, the diversity of monitoring approaches across Canada, along with the difficulties involved in pooling data from province to province, makes the centralization of data on a Canada-wide basis almost impossible.
This makes it difficult to assess prevention measures with a large enough sample size to draw conclusions and interferes with the smooth and timely management of outbreaks. Moreover, this doesn't give us the chance to learn from our successes or failures.
I applaud the CIHR's quick launch of competitions for operating grants for a rapid research response to COVID-19 to address the pandemic issues in real time.
Ironically, in the current pandemic situation, clinician-researchers who serve as infection control officers and who identified relevant research issues as part of their daily work were unable to submit a project as principal investigators in the first CIHR competition. These clinician-researchers were all managing the pandemic in their respective facilities with an increased workload. At the same time, the CIHR cancelled the March competition and asked everyone to apply again for the regular September competition.
However, in the current situation, the researchers involved in the management of COVID-19 will be at a disadvantage, since no preliminary data will be available to improve the application submitted six months later.
Infection control research is critical, whether or not it concerns COVID-19. The research provides the necessary input to the federal and provincial advisory committees, which make recommendations to departments. The departments will ultimately make the decisions. The research also helps improve techniques and approaches used in facilities and in the community.
Lastly, we can't overstate the need for infection control and the associated research to prevent the development and spread of infections in the community and in health care facilities, including CHSLDs. Proper investment in this key health care sector would have saved lives and public money.
We must learn from our past mistakes and take the necessary steps to ensure a proper and quality infection control system. Infection control improved dramatically after the Clostridium difficile crisis. Hopefully, further progress will be made after the COVID-19 crisis.
Thank you for your attention.
Thank you, Mr. Chair, and thank you to all of the committee members for inviting me to speak in front of the committee.
I am a medical microbiologist and infectious disease specialist at the Centre hospitalier de l'Université de Montréal and full professor and director of the translational HIV research chair at the Université de Montréal, where I led two pan-Canadian cohorts on HIV research. I was the director of the Quebec public health laboratory from 2012 to 2015 and was co-chair of the Canadian Public Health Laboratory Network during this period.
Today, I'm talking to you as a researcher, a clinician and a public health scientist.
Let's talk research. First, I want to congratulate the Canadian government on its rapid response to the pandemic with the investment of specific funds directed at COVID-19 research very early on in February, and then again in the month of May. There was an urgent need to support research teams already in place in order to advance innovation, mostly in treatment and vaccine development, to counter this pandemic. That's the good news, but there is still so much we need to learn to better understand this disease pathogenesis and, as well, to analyze our response to this pandemic and better prepare for the future.
To date, the funding opportunities that were launched were short-term opportunities only—less than a year—yet look at what needs to be done to win this battle. We have to characterize the host responses to the virus, such as, for example, what drives these multisystemic inflammatory responses and how to treat them; understand SARS CoV-2 replication and its genetic evolution over time; characterize the quality and durability of natural as well as vaccine-induced immunity in various populations, such as the immunosuppressed, the elderly and children; and, understand the dynamics of pandemics in terms of what went wrong, and whether we can build tools, models, to better predict the next phases or next pandemics.
All of this takes time—time and money. However, as I mentioned, the last funding opportunity was directed at one-year projects only. Over 1,800 applications were submitted, which reflects the interest and innovation potential of our Canadian research community, but only a few of these will be funded, and then what? There are no more announcements regarding future funding opportunities. The Canadian Institutes of Health Research cancelled their spring competition, and we don't know what will happen with the September competition, which is directed at research projects in all domains outside COVID-19.
It is urgent to invest more funds for COVID-19 research. The government needs to launch a phase three in its COVID-19 research investments. This phase should be directed at gaining three things. They are to get a better understanding of the virus and its complex interactions with humans; to better understand our immune responses; and, equally important for the future, to learn the clinical, social and epidemiological lessons from this pandemic in both the mid-term and the long term.
Furthermore, why not take the opportunity to create a research infrastructure to monitor viral diseases over decades? This observatory would follow a cohort of individuals across the country who regularly would donate blood and clinical data that would become an extraordinary platform to identify, characterize and predict future zoonotic viral illnesses.
From a clinical standpoint, I'm concerned about our preparedness for the second wave of the pandemic. Do we have enough personal protective equipment, swabs and reagents for laboratory testing in the fall? What does our stockpile look like right now? Will we be caught in the same unprepared situation as at the start of the pandemic? It seems vital that, both in the short term and long term, Canada be self-sufficient in terms of manufacturing these essential materials to manage an epidemic and protect our health care workers.
In addition, the current epidemic has highlighted the shortcomings of our health care systems, especially the shortage of personnel in all categories, from nursing aides to maintenance workers to nurses. Governments should reinforce training programs that will encourage young people to enter different health care professions, through scholarships, enhanced university programs combined with support for universities, and better working conditions for all personnel. They are the health care system.
Lastly, we've hardly touched on the use of new technology to manage epidemics. It's 2020. Artificial intelligence should be at the forefront of research activities. Tools should be developed to serve public health needs while respecting individual confidentiality. Artificial intelligence should become a research and development priority. The tools should be standardized across Canada to synergize our capacity to control a pandemic.
Many lessons will be learned from this pandemic. Researchers in basic science, public health, social science and clinical fields should play a pivotal role in analyzing the determinants of this crisis and preparing us for the next one. We must review our pandemic preparedness plans. The time has come to invest in research and to train the next generation so that these lessons are based on science and so that the solutions are anchored in evidence and sound scientific thought.
Thank you for your attention.
I'll take this one, if you don't mind.
What we know is that, in certain circumstances, particularly when you're in a hospital and you do medical procedures, you might be able to aerosolize that virus. For instance, if you intubate a patient, if a patient is on CPAP, when you go in the airways, we know that it aerosolizes the virus. That's why we put them in negative pressure rooms. We wear N95 masks and all the rest.
What is still not completely clear is what happens when a person coughs or does physical activity and breathes out very strongly. I think that what seems to happen is that you are able to have smaller droplets that will be suspended in the air for five to eight minutes, but it's not per se for now in aerosol.
Studies are currently ongoing, particularly in long-term care facilities where we're all wondering if airborne transmission is not happening, given the proportion of people who become infected when they just go into those facilities. Air sampling is being done with cultures of air. We know that we are able to find pieces of viruses in the air in long-term care facilities, but we don't know if that's a piece of a virus that's dead or if it's a virus that's still able to replicate.
The studies are ongoing right now, and I think we'll have the results within the next month or so. At that point in time, we'll know. At this point in time, I think daily living will cause droplets that may be suspended in the air for five to eight minutes, like when you sing, for instance, and when you cough very hard, and that is still able to infect the next person. Aerosolization per se for now is not yet approved upon.... The jury is still out, as Dr. Tremblay would say.
Thank you, Mr. Chair, and thank you to all our presenters today for their opening comments.
I want to talk a bit about the research grants that are available out there.
Dr. Mossman, you talked about your funding and how that's being provided by the CIHR.
Dr. Wright, you are very grateful for the funding you're getting, according to your testimony here.
Dr. Tremblay, you congratulate the government for the money that it put toward research, although you've mentioned that short-term funding opportunities have the only available research dollars and you see no more future announcements for funding.
The committee, back on April 14, heard that the CIHR, in collaboration with the provinces, was able to invest $54.2 million to support COVID-19. On April 23, our committee heard that an additional $115 million in funding was allocated as part of a $1.1-billion national medical research strategy for COVID-19.
In hearing from all of you today, some of you are grateful for the funding you're receiving, others not so much.
Dr. Quach-Thanh, you mentioned that it is difficult to obtain grants from the CIHR. I'm just a bit confused here. Some of you are happy with the research dollars and others are not. How many more billions of dollars do we need in order to satisfy the researchers in Canada?
I'll start with Dr. Quach-Thanh, please.