I call this meeting to order.
Welcome, everyone, to meeting number 19 of the House of Commons Standing Committee on Health.
The committee is meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.
I would like to welcome the witnesses.
From the national advisory committee on immunization, we have Dr. Caroline Quach-Thanh, chair and professor, Université de Montréal.
From the Public Health Agency of Canada, we have Stephen Bent, director general; Kimberly Elmslie, senior vice-president; Bersabel Ephrem, director general, Centre for Communicable Disease and Infection Control; Cindy Evans, vice-president, emergency management; Dr. Guillaume Poliquin, acting scientific director general; and Dr. Roman Szumski, senior vice-president, COVID-19 vaccine and therapeutics acquisitions.
I would just summarize that the above witnesses are asked to present on the following: (a) current outbreaks, occurrences and modelling for COVID-19 variant spread in Canada as it relates to projected vaccination rollout timelines; (b) capacity to surveil the emergency prevalence and spread of variants; (c) current federal government assumptions regarding vaccine effectiveness on variants in the context of the federal government's vaccine portfolio and (d) Canada's procurement of variant-related booster shots.
According to the motion that requested this panel, I will ask Dr. Quach-Thanh to speak for up to seven minutes followed by the Public Health Agency of Canada for up to 15 minutes.
Dr. Quach-Thanh, please go ahead for seven minutes.
I would like to begin by thanking the Chair and the members of the Standing Committee on Health for inviting me to testify.
I am a pediatrician, a microbiologist-infectiologist and a clinical researcher at CHU Sainte-Justine, as well as a full professor in the Department of Microbiology, Infectiology and Immunology at the Université de Montréal. I have clinical and research expertise in infection control from hospital to community, which also includes vaccination. I hold a Tier 1 Canada Research Chair in infection prevention and control: hospital to community. However, I am testifying today as Chair of the National Advisory Committee on Immunization, or NACI, so I will limit myself to that committee's mandate.
The National Advisory Committee on Immunization, or NACI, is an external advisory committee to the Public Health Agency of Canada and has existed since l964.
The NACI work and committee attendance for the 15 voting members and the chair is done on a voluntary basis and carefully reviewed for any conflicts of interest.
NACI makes recommendations to the Public Health Agency of Canada on issues relating to immunization for the vast majority on vaccines that have been authorized by Health Canada. In only one instance was NACI asked to make recommendations on a not yet authorized vaccine to support emergency preparedness, the Ebola vaccine.
NACI bases its recommendations on various elements, including the burden of illness; vaccine characteristics such as safety, immunogenicity and efficacy; ethics; equity; feasibility and acceptability as well as economics.
To ensure that NACI has the proper expertise, it expanded its voting membership in recent years to include a social scientist, two health economists and an epidemiologist and consults regularly with the Public Health ethics consultative group.
NACI uses a systematic approach to review the medical literature and vaccine science, which may take longer to perform compared to a narrative review, but ensures reproducibility and quality so that provinces and territories are confident about the knowledge synthesis product they can then use for their local recommendations.
Given the growing need for recommendations with respect to vaccination against COVID-19, the NACI has increased the frequency of its meetings, sometimes to one per week. The secretariat supporting the NACI within the Public Health Agency has worked diligently to provide the NACI with the information it needed to make decisions, including scientific literature reviews, ethical analyses and management option tables. This has allowed for a variety of approaches based on provincial values and epidemiology.
Since the beginning of the pandemic, the NACI has issued a number of statements: a statement on research priorities to guide manufacturers' phase III randomized trials, so as to answer key questions that will enable the NACI to make recommendations on the use of vaccines for various populations, including vulnerable individuals; four recommendations on priority groups for vaccination in various circumstances; and two recommendations on the use of vaccines for COVID-19, including one for each of the vaccines approved by Health Canada.
Given the questions on variants asked by HESA and in keeping with the NACI mandate, I cannot comment on the vaccine rollout. However, NACI has variants of concern, VOCs, on its radar, having added many research questions over time in our recommendations on the use of COVID-19 vaccines; the latest version remains to be published. These research questions feed both the Canadian Immunization Research Network's work plan and the newly formed vaccine surveillance reference group, safety and effectiveness working groups, to identify knowledge gaps and leverage existing cohorts or surveillance infrastructure to answer these questions.
The following questions relate to VOCs: What is the role of humoral versus cellular immunity in preventing immune escape of viral variants? How will viral variants impact the efficacy, effectiveness, immunogenicity and safety of a vaccine with respect to death, severe illness, symptomatic disease, asymptomatic disease, infectivity and transmission? What is the effect of using booster vaccines containing heterologous antigens and what is the optimal timing for booster vaccination?
At this point, NACI has requested presentations of vaccine effectiveness data from the U.K. where the B.1.1.7 variant is the most predominant SARS-CoV-2, in a country where both AstraZeneca and Pfizer-BioNTech are used with an extended interval of 12 weeks. Data were presented to NACI confidentially on February 8, 2021, after four weeks of follow-up of individuals vaccinated with the Pfizer vaccine. Public Health England will be presenting an update on their results again next week at the regular NACI meeting.
Based on data from the literature, NACI considers that the available mRNA vaccines remain effective against the VOC that emerged in the U.K. Studies show that following one dose of the Pfizer-BioNTech, participants' sera exhibited a broad range of neutralizing titres against the wild-type virus that were only modestly reduced against the B.1.1.7 variant.
The introduction of the E484K mutation in a B.1.1.7 background led to a more substantial loss of neutralizing activity. Neutralizing antibodies were lower in those 80 years and over in a separate study. However, antibody response, as key as it may be, is not the only type of immunity that is of importance: cellular immunity also plays an important role in protecting the individual.
As there are no known correlates of protection, and as we are likely going to see the emergence of other new variants over time, it is paramount that Canada and the world invest in surveillance and tracking of variants, identifying those of concern; analyze new variants' sensitivity to neutralization by vaccine recipients' sera; study vaccine protection of animals against challenge with new strains, and sequence viruses causing breakthrough infections in vaccinees. This will allow for real-time vaccine effectiveness surveillance alongside VOC's identification and surveillance.
The spread of the VOC that emerged in South Africa, the B.1.351, may be more detrimental. Data from recent randomized clinical trials where VOCs were circulating showed that although these vaccines, the vector-based and Novavax, remained efficacious against the B.1.1.7 variant, they had decreased efficacy against the South African variant.
The phase 3 studies that were conducted for the mRNA vaccines were done at a time when VOCs were not yet prevalent. However, we are aware that some of the leading vaccine manufacturers are already working on new versions of their COVID-19 vaccines adjusted to target B.1.351 or other variants. NACI is monitoring the data and will issue a statement if a booster or a new dose is needed, including consideration of any new vaccine candidates that are authorized by Health Canada.
NACI is also monitoring the use of heterologous vaccine schedules. Preliminary results from an animal study showed that a combination of mRNA and AstraZeneca elicited a stronger cell-mediated immunity. The U.K. started a study whereby AstraZeneca and Pfizer will be administered as a mixed schedule. Recruitment started at the beginning of February, and NACI will be monitoring the results from this study.
For over 50 years, NACI has been providing evidence-informed, expert advice to the Government of Canada on vaccines. Viral variants or different strains of diseases are not a new phenomenon, and we have a long history of adapting vaccine programs to the changing evidence in areas such as influenza, where new vaccines are needed every year, or pneumococcal disease, where different strains have waxed and waned requiring dynamic vaccine technologies and program redesign over the years. NACI is poised to adjust this new vaccine program, if needed, as the evidence evolves.
I thank you for your attention and will be happy to answer questions as they relate to NACI's mandate.
Mr. Chair and honourable members, thank you for this opportunity to speak to you about COVID-19 variants and the actions the Public Health Agency of Canada is taking to protect Canadians during this pandemic.
I would like to start with a bit of background information on variants. All viruses mutate over time. It's only natural that the virus that causes COVID-19 will also mutate. By mutate, I mean change the genetic material in the virus. While all viruses mutate, not all mutations are of concern. A variant of concern is a mutation that has the potential to have an impact on the characteristics of the virus. A variant is of concern when it affects the disease spread, the severity of the disease, the vaccines and treatments or the tests used to detect the virus.
We are working with international partners, including the World Health Organization, to build our knowledge base and better understand the COVID-19 variants and their potential impacts. In recent months, several COVID-19 variants of concern have emerged internationally. As of yesterday, we are aware of three variants of concern in Canada: those first identified in the United Kingdom, South Africa and Brazil.
The situation with variants of concern in Canada continues to evolve rapidly. As of February 16, across provinces, a total of 637 cases associated with variants of concern have been reported publicly. To date, there have not been any variants of concern identified in any of the territories.
The majority of the cases in the provinces have been of the B.1.1.7 variant first identified in the United Kingdom. The majority of cases related to this variant are linked to travel. However, there is evidence of community spread as there have been cases without any direct or indirect link to international travel or to travellers.
Five provinces—British Columbia, Alberta, Ontario, Quebec, and Nova Scotia—have confirmed the B.1.351 variant first identified in South Africa. So far, the P.1 variant first identified in Brazil has been confirmed only in Ontario.
Between mid-January and mid-February 2021, there have been 21 outbreaks of COVID-19 in Canada associated with a variant of concern. These have occurred in a variety of settings, including long-term care facilities, workplaces, health care settings, child care centres, schools, residential apartments and social gatherings.
Ontario has reported the majority of these outbreaks, with a total of 13. Quebec has reported four; Alberta, two; and, Manitoba and Newfoundland and Labrador, one each. The variants of concern continue to spread in Canada, and it's likely they will become more widespread over time.
We are continuing to track emerging variants both in Canada and internationally. As our understanding of these variants increases, we will update our guidance on case and contact management and community-based measures. Evidence from other countries shows that COVID-19 activity can be brought under control even when variants of concern are widespread.
Strict public health measures, along with strong border controls and strict adherence to personal protective practices, can slow the spread and impact of variants of concern. Slowing the spread will buy us the time we need to get Canadians vaccinated.
Vaccine manufacturers are investigating the impacts of the known variants of concern on their vaccines. There are reports that certain types of vaccines may be less effective against the variants of concern first identified in South Africa and in Brazil. However, given the limited data on the new variants of concern, more research is needed to confirm these early findings.
As new variants are identified, it's more important than ever that we continue to follow recommended public health measures.
Since the beginning of the pandemic, public education and communications have played a critical role in the Government of Canada’s response to COVID-19. We work closely with the provinces and territories, public health partners, multicultural and indigenous organizations and other stakeholders to make sure that information is accessible to all Canadians and that up-to-date information and public health guidance are available through a wide variety of channels.
I would now like to turn to my colleague Dr. Guillaume Poliquin. He will talk to you about sequencing, surveillance and vaccines.
As my colleague mentioned, I will be talking to you about sequencing, surveillance and vaccines.
Canada has a federal, provincial and territorial approach to surveillance. This involves front-line healthcare settings and laboratories across the country. Our approach has effectively equipped us to detect respiratory diseases, including COVID-19.
We have worked with the provinces and territories and other stakeholders to accelerate diagnostic testing capacity in order to detect cases of COVID-19 and its variants more quickly.
The National Microbiology Laboratory monitors Canadian cases of COVID-19 with the provinces and territories through ongoing analysis of genomic databases in Canada.
Since the beginning of the COVID-19 pandemic in Canada, the Public Health Agency of Canada, Health Canada and the Canadian Institutes of Health Research have been working with Genome Canada, and provincial and territorial partners, on sequencing.
Sequencing is used to determine the RNA of the virus in order to help identify different variants. This data is an essential tool to track how the virus is both changing and spreading. This method can help us quickly detect potentially emerging variants of concern.
In April 2020, the Government of Canada committed $40 million to support the creation of the Canadian COVID-19 Genomics Network, or CanCOGeN. This investment will enable sequencing efforts across the country that will help us understand the genetic variations of the virus as it evolves.
These early investments have helped put Canada in a leadership position so that we can rapidly detect and respond to the variants of concern that have emerged and are spreading around the world. The National Microbiology Laboratory and the Canadian COVID-19 Genomics Network have worked with federal, provincial and academic scientists, epidemiologists and infectious diseases clinicians to establish priorities for sequencing.
These activities target the identification of existing variants of concern through the regular sampling of positive cases. These include, but are not limited to, suspected cases of reinfection and vaccine failure. Sequencing is also targeting high-risk scenarios that may signal the presence of potential new variants of concern. Canada sequences more than 5% of the positive caseload in the country, a rate on par with most top surveillance programs in other countries. Our objectives are to increase our sequencing to 10% and to decrease turnaround times.
The National Microbiology Laboratory is working with provincial partners to ramp up screening positive cases of known variants of concern. Screening capacity is increasing in many provinces.
At the same time, the Public Health Agency of Canada is tracking daily counts of variants of concern across Canada. It has also worked with provincial and territorial partners to reach agreements to track cases that have been identified as variants of concern. This agreement includes sharing epidemiological information so that we can do a comparative analysis of concern cases versus cases where the variants are not of concern. This analysis will allow us to detect characteristics that might enhance our understanding of how public health measures need to be adapted to a variant of concern.
To further support our efforts, the government is investing $53 million in an integrated Variants of Concern Strategy. The investment will increase our capacity to find and track variants of concern in Canada. It will also help to rapidly scale up surveillance, sequencing and research efforts to inform the public health response.
This national strategy brings together public health and genomic sequencing, along with epidemiology, immunology, virology and mathematical modelling. Through this partnership, we are leveraging existing expertise and laboratories to drive public health investigations and take public health action rapidly.
To implement the strategy, the Public Health Agency of Canada's National Microbiology Laboratory is providing $20 million. CanCOGeN is providing $8 million to increase genomic sequencing and real-time data-sharing capacity. The Canada Institutes of Health Research are providing up to $25 million to scale up Canadian research to increase our understanding of emerging variants. This will help provide decision-makers with rapid guidance for drug therapy, vaccine effectiveness and other public health strategies.
The Public Health Agency of Canada is responsible for supporting and acting on the recommendations of the COVID-19 Vaccine Task Force. Based on the expert recommendations of the task force, clinical information, and authorizations by Health Canada, the Agency has worked with Public Services and Procurement Canada and other federal departments to develop an evidence-informed vaccination strategy. This strategy focuses on securing a diverse portfolio of leading COVID-19 vaccine candidates.
The portfolio of candidates serves to provide every person in Canada with access to safe and effective vaccines as soon as they are available.
Canada was an early investor in COVID-19 vaccine technology, and has advance purchase agreements with seven leading vaccine manufacturers. To date, the Pfizer and Moderna vaccines have been authorized by Health Canada. Three others, AstraZeneca, Janssen and Novavax, have submissions with Health Canada for regulatory authorization. Others are progressing well through clinical trials. Canada's approach to its vaccine strategy was designed to take into account the uncertainties and many risks inherent in global vaccine supply chains. It also considered the evolving nature of the virus and its impacts on vaccines.
The current global emergence of variants of concern has reinforced the value of having a diversified portfolio of vaccines. Canada is monitoring evidence of the impact that variants of concern have on the effectiveness of the vaccines in our portfolio.
The Public Health Agency of Canada strongly supports evidence-based decision-making and continues to work closely with its partners to monitor the evidence on all fronts. And we continue to adjust our efforts when necessary.
The agency is working with the provinces and territories, international partners, the scientific community and health systems to collect evidence on the variants. This will help us determine how they are impacting on Canada's immunization efforts, as well as those of other countries.
At the same time, the agency is working with its federal partners to engage vaccine developers on on how their vaccines will protect against variants, including the potential need for booster doses.
In our current portfolio, we have secured enough vaccines for everyone in Canada to have access to an authorized vaccine by September. We are confident in our vaccine portfolio but we recognize that it is not static. As we learn more, we will adjust the strategy to ensure that it continues to be effective.
We are actively exploring all options that can help us strengthen our vaccine portfolio and support our immediate and longer-term needs. This includes making sure that all Canadians have access to boosters, if they are required.
To say this last year has been a difficult one is an understatement. But we have come a long way. We have seen the positive effect of the public health measures we have been practicing. They are effective and they help to prevent the spread of COVID-19, including its variants of concern.
Now is not the time to give up. We've come too far for that. Until we are all vaccinated, it is more important than ever that we maintain the practices that have brought us this far.
Thank you for your attention.
I will take advantage of your presence, Dr. Quach-Thanh, to ask you some questions.
First, I would like to thank you for being with us again. You have come to see us a few times. I hope that we will be able to get a copy of your speech as well as all of the speeches that were given today. As yours was very technical, I'd like to try to put it all in a little simpler terms. People have concerns. Mr. Powlowski spoke earlier about the issue of a single dose and the interval between two doses. People are concerned about whether they should get booster shots.
The data presented yesterday by the Institut national de santé publique du Québec, or INSPQ, was quite intriguing. It was good news. Basically, the INSPQ told us that the first dose of the vaccine is 85% effective and that the second dose would only increase effectiveness by 10%. In addition, the second dose could increase the duration of protection, but it's unclear how long that duration would be. However, it is also possible that a single dose could lead to revaccination.
Given the fact that as many people as possible would need to be vaccinated to achieve herd immunity, what do you think of this news? Do you feel the second dose is necessary? Isn't it just a prerogative of a company that wants to promote its brand and make doubly sure that it's going to work? This information is a total game-changer.
Thank you for the question.
I have read the data from the INSPQ, and it is very intriguing indeed. It's also very good to have 85% effectiveness in a very elderly and very sick population living in long-term care centres, or CHSLDs.
According to the immunological data, the second dose makes the antibodies become more mature and therefore much stronger and more active. It is as if a key fits even better in a lock, allowing for longer-term protection.
Using a single dose is risky right now since we don't have any data on a single-dose program. We may eventually get some.
For example, we have some data on the single-dose program with the Johnson & Johnson vaccine, but, given the little we know about it, that vaccine is slightly less effective against the South African variant. So the manufacturer is now conducting studies on adding a second dose to see if it will make any difference.
It's not so much the added 10% effectiveness that prompts us to give a second dose. It's really about longer-term protection. We wouldn't want to have to go through the vaccination process over and over again. We want people to be protected against the viruses that are circulating.
In addition, the study published by the INSPQ was conducted in Quebec at a time when we had no variants of concern. Effectiveness of 85% was only established for the field virus. We will need to continue to monitor. As Dr. De Serres said, when we see the effectiveness starting to drop, it will probably be time to give the second dose. For now, Quebec is planning a three-month interval between the two doses. So the initial deliveries will mean many more people can get vaccinated.
From the perspective of undertaking an immunization campaign this large and complex, I know that everybody in this room knows that this is unprecedented for us. What isn't unprecedented is the fact that we work really hard with provinces and territories and with public health officials across the country every day on preparedness and on execution.
When it comes to this operation, we have set up a national operations centre that is running the logistics for distribution and is on top of vaccine deliveries 24-7. We have a committee of federal, provincial and territorial officials, and those people are on-the-ground program immunization deliverers who are talking twice a week, if not more, about the things that they are seeing on the ground so that we can, at the federal level, support immunization program delivery.
How do we do that? We do that by, for instance, ensuring that those programs have the types of syringes that they need to immunize Canadians. When Pfizer went to a six-dose vial from a five-dose vial, we provided, at the federal level, the syringes that provinces and territories required to be able to get that sixth dose. We are also working with them every step of the way to look at issues of effectiveness and safety.
That's another important part of the rollout of an immunization campaign. It's not just getting the needle into people's arms, it's also doing surveillance after they've been vaccinated to see what the effect of vaccination is. That involves us using, for instance, vaccine registries that are in provinces and territories and that we have provided additional support to so that we're getting good data, and provinces and territories themselves are able to monitor what's going on in their jurisdictions.
From all of those various pieces of, I'll call them, infrastructure and machinery...both are things that have been in place for a very long time. As Dr. Quach stated, every year we roll out 12 to 15 million influenza shots across the country. Provinces and territories deliver those in clinics, in doctors' offices and in pharmacies, so we're obviously very well prepared for this kind of venture, which is more complex.
We've beefed up everything so that we are able to be much more consistent in our execution and we've practised. We've had proof-of-concept demonstrations with our colleagues at round tables doing tabletop exercises and doing the kinds of things that one would do in terms of challenging each other on the what-ifs. What if this happens? How are we going to handle it? All of these things are part of the preparedness that we undertake with all jurisdictions on a regular basis.
I'd be happy to do that.
As Dr. Quach indicated, the National Advisory Committee on Immunization is a long-standing committee that has been providing advice to the Government of Canada, to the Public Health Agency, on the optimal use of vaccines in the population over many years. They do their work by looking at the science and evidence that is available and they are experts in their fields of immunology, pediatrics, infectious disease, behavioural science and economics. They consult with the public health consultative ethics group and their job is to, with all of that combined data and expertise, look at benefits to the Canadian public of particular approaches to vaccination.
We rely on that expertise, and we rely on the independence of the committee, to bring forward the guidance that provinces and territories take into account as they make their own decisions on how they will implement their vaccination programs.
The committee publishes statements, as you will have seen, on the COVID situation and they update those statements as more evidence comes to bear. They use systematic methods for the analysis of their data so it's always done according to international standards. They are one among a number of international committees called NITAGs, national immunization technical advisory groups, that work together and work independently as well to provide both global as well as domestic advice on optimal use of vaccines.
Their advice has stood the test of time in this country. We see the success of vaccination programs and we see the success of efforts to prevent vaccine-preventable diseases. We also see from NACI where more research is needed and where there are gaps in our efforts to ensure that our population is well protected from vaccine-preventable diseases.
You said, however, that having more doses available didn't increase the speed of vaccination. In my opinion, it would allow us to speed it up.
Having said that, how is it more effective if the people who need to administer the vaccine can't extract the doses?
The decision was made on February 9. In early February, Rick Hillier had said that the sixth dose couldn't be extracted 80% of the time and that, for some deliveries, it couldn't be extracted at all. In Quebec, it was one out of five times.
Aside from the fact that it's in our interest to have more vaccines and doses, how is it more effective or faster if there are practical difficulties in extracting all the doses? Why did you support this decision and change the parameters of a contract?
I understand that the contracts are the responsibility of Public Services and Procurement Canada. However, when it comes to public health and vaccine efficacy, real issues still exist. Are you compiling all of these issues at the Public Health Agency?
I would ask you to send your responses in writing to the committee, if the chair decides there isn't enough time.
Herd immunity, as you mentioned, is a concept that we hear about a lot. Some areas of science will put percentages around it, saying we need to reach a certain level of immunization in the population to achieve herd immunity. Others will talk about it in terms of time frame.
From a public health perspective, we in the field are cautious when it comes to pronouncing on a particular percentage of the population required to achieve herd immunity, which is essentially a place where the virus can no longer efficiently transmit because people are protected; either they have been protected through vaccine-induced immunity or through natural infection and they are now immune. When the virus has nowhere to go, it can't continue to transmit and you have achieved herd immunity.
That protects people who are unable to be vaccinated because, for example, they may have contraindications to a vaccine and therefore not be able to receive it. Allergies may prevent them from receiving it. When you reach that place where the virus has no efficient way to transmit between people, then essentially you've reached herd immunity. You see drops in the level of disease in the population and, of course, in transmission.
We are monitoring all those indicators at the Public Health Agency. We're looking at vaccine effectiveness, what kinds of transmission rates are being seen within subgroups of the population, the reproduction factor, all of them. As you said, it's complex but at the same time, the concept is a pretty simple one. We will be looking at those indicators as vaccine rollout continues and public health measures continue to be implemented to see the spread of the virus decrease.
Thank you very much, Mr. Chair.
Ms. Elmslie, I want to thank you for hitting the nail on the head there. It's the evolution of science. That explains so much. From day one, this has been a rapidly evolving situation. I know that all of the people who are taking care of Canadians and watching over the health and safety of Canadians are constantly monitoring new data every day as it arrives.
I think we all agree, on this committee, that we have to do everything we can to protect Canadians from COVID, especially with these new variants. One new case of COVID is too many. I want to thank all the witnesses today for the work that you do, every day, because I suspect that you live this. You live this, and you have for probably a year.
You didn't get a chance to answer all the questions that were asked of you. Members are very tight with time. We have a lot of constraints on the time here and you didn't get a chance to answer all the questions you were asked. You specifically mentioned the importance of a multi-layered approach to controlling and preventing COVID-19.
Since I'm on with you, Ms. Elmslie, I wonder if you could elaborate on this multi-layered approach on how we need to take every step to make sure we ensure the safety of Canadians.
I'd like to tell the witnesses that the answers they can give us in writing in the next few days will be just as important as the answers they can give us today. It's important that they understand our concerns.
Of all the people who are with us today, no one could have imagined on February 19, 2020, the narrative of the crisis we are experiencing. Nor could anyone have claimed to know that there would be so many questions about vaccine efficacy, since the possibility of creating a vaccine in such a short time wasn't even considered. So there are negative aspects and positive aspects. I'm going to talk about one of the negative aspects.
At one of the committee meetings, I had asked Dr. Tam whether, in hindsight, she felt that she should have recommended more quickly that the border—one of the longest in the world—be closed. She ultimately said yes. It's always important to be modest and humble when dealing with a crisis like this, unless you have the science to back it up. The Public Health Agency of Canada has a responsibility for border management as part of pandemic management, as well as a responsibility for consultation and advisory services.
This week, the land border was open. Quebec was concerned about the upcoming spring break and had asked for a tightening of the rules. For us in Quebec, the spring break was the determining factor in the spread of the virus.
Ms. Evans, have you documented the border crossing issues that have occurred this week, particularly at the Lacolle land border office? Have you corrected them?