I now call this meeting to order.
Welcome, everyone, to meeting number 21 of the House of Commons Standing Committee on Health. We're meeting today to study the emergency situation facing Canadians in light of the second wave of the COVID-19 pandemic.
I would like to remind everyone that you have the right to participate in these proceedings in the official language of your choice. In the event of difficulty hearing the translation, please bring it to our attention as soon as possible so that the matter can be resolved.
I'd now like to welcome the witnesses.
Appearing as an individual is Dr. Joanne Langley, professor of pediatrics and community health and epidemiology. Appearing with Dr. Langley is Mr. Roger Scott-Douglas, secretary of the COVID-19 Vaccine Task Force. He will not make a presentation but will assist Dr. Langley in answering questions. Also appearing, in this case as an individual, is Dr. Andrew Morris, professor of infectious diseases. From the Canadian Nurses Association, we have Michael Villeneuve, chief executive officer; and Aden Hamza, policy lead. From Doctors Without Borders, we have Dr. Jason Nickerson, humanitarian affairs adviser.
Before we go to the statements, I will advise everyone that I will be using a yellow card to indicate when there's approximately one minute left and a red card to indicate when your time is up. At that point, please try to wrap up.
We'll start with Dr. Langley.
Dr. Langley, please go ahead for five minutes.
My name is Joanne Langley, and I am speaking to you today from Nova Scotia. I'd like to start by acknowledging that my workplace here at Dalhousie University and the IWK Health Centre sit on the ancestral and unceded territory of the Mi'kmaq.
Thank you for the invitation to the House of Commons Standing Committee on Health.
Thank you, members of Parliament, for your services to the country.
I'm a pediatrician specializing in infectious diseases. I'm also a vaccine researcher and clinical epidemiologist. I've been honoured to work over several decades with public health colleagues on communicable disease control and vaccines to prevent and limit the spread of infectious diseases. These challenges that we have worked on together include the 2003 SARS outbreak, various local and regional epidemics and the last pandemic in 2009 due to influenza. The current pandemic, which has affected the physical, mental, social and economic well-being of humanity across our globe, has been unprecedented.
All of us have been heartened by the speed at which science and dedicated hard-working humans have delivered safe and highly effective COVID-19 vaccines. These advances in vaccine development are also unprecedented, but the work is not over. There are important tasks ahead for this year and, in my view, likely for a few years.
We must not become accustomed to this suffering, which has affected all people, including children. Now is the time for lofty goals and for solidarity. Words and deeds matter. We must support our health care professionals as they take care of the sick. We must support our public health workers as they implement what is the largest vaccine rollout in our country's history. We must continue public health measures and support for them until we understand the natural history of this virus.
There is much remaining basic and clinical science research to be done, and we must continue to strive to collaborate across all the man-made divisions that exist now to work together. While we protect people within our own borders, we must continue to lift our gaze to the protection of the peoples of the world, to the low- and middle-income countries, and how we can serve them.
I'd like to make a few closing comments about the role of vaccines in ensuring a healthy society. Immunization has been cited as one of the top 10 public health achievements of the last century. When there isn't a pandemic, I would argue that vaccines do not always get the attention they deserve. At this time, Canadian children are protected against 16 different infections. Vaccination can prevent whooping cough, death, disability and serious illness. Adults, too, have a schedule of vaccines that can prevent influenza, shingles, pneumonia and other life-altering infections. Immunization is a strong and dynamic system, but somewhat fragile.
Thank you, Mr. Chair, and honourable committee members. It's an honour to be able to address this committee.
Before I begin, I'd like to acknowledge that I'm currently speaking from what I believe to be the unceded ancestral territory of the Haudenosaunee, which is where my family home currently rests.
I'm a professor of medicine at the University of Toronto and a consultant in infectious diseases at Sinai Health and the University Health Network. Prior to this pandemic, most of my academic work was really focused around antimicrobial resistance—drug-resistant infections. I've been doing work on behalf of the Public Health Agency of Canada, along with Gerry Wright, to develop a pan-Canadian network to tackle antimicrobial-resistant infections.
This is my third such appearance before the Standing Committee on Health in relation to infectious diseases in the past four years. I'm really privileged to be invited again. As I will remind this committee—in fact, the only familiar face I see here is Mr. Davies', so there are many new faces—much of the action that I've urged this committee to act on previously has not occurred.
Although it was self-evident at the beginning of the pandemic when the virus was first isolated, it's worth reminding everyone that COVID-19 is just one of a host of drug-resistant infections. There are many drug-resistant infections that affect Canadians annually. Sadly, we estimate that we've lost around 22,000 people to COVID-19 over the past 12 months, and many more have become sick. We lose about one quarter of that figure annually due to drug-resistant infections at a cost to the Canadian health care system of $1.4 billion, with a reduction in GDP of about $2 billion. We expect that those numbers are going to rise to about $7.6 billion in health care costs and $21 billion in GDP by 2050.
We're now roughly a year into this pandemic, and it would be sufficient to say that the lives that we're going to continue to see lost around the world, including in Canada, will be due to a combination of two things. One is insufficient vaccination, primarily limited by supply, and the other one will be ineffective antimicrobial therapy. I do want to point out, as Dr. Langley also pointed out, that as citizens of the world, both of these issues affect people throughout the globe.
We need to invest in infectious diseases prevention, surveillance, diagnostics and therapeutics. I think I'm going to attenuate what I was going to say for reasons of time, but I will point out that our surveillance systems in particular remain so poor that at present we've had to put together a hodgepodge of genomic sequencing resources to try to give us the surveillance information that countries like Denmark, which has one tenth of Canada's population, and the U.K., which has roughly double our population, can provide to their own citizens. We also lack the capacity to develop antimicrobials, and we're unable to produce vaccines to serve our citizens.
We have not been able to mount a coordinated response to infectious diseases, and I really want to focus for the next while on drug therapy. I will start by pointing out that there are two evidence-based therapeutic treatments for COVID-19 that unequivocally save lives in hospitalized patients: dexamethasone, which is a cortisone-like medication, and tocilizumab, which is a monoclonal antibody that blocks a component of the immune system. Both of these agents are life-saving with comparable and additive effects.
At present, we have sufficient supply of dexamethasone across the country. It's a cheap, generic drug. On the other hand, we have insufficient supply of tocilizumab for the needs of Canadians. Whereas I do understand that the federal government along with the provincial governments have been making efforts to procure sufficient supply, provinces have been sheepish to provide tocilizumab to patients whose conditions merit its use because of uncertain drug supply. This is an unquestionably life-saving drug.
The last point I want to make is to contrast these stories with the stories of remdesivir and bamlanivimab. Yes, if you're wondering, as an infectious disease physician I'm used to pronouncing organism and drug names that the rest of humanity struggles to pronounce.
Remdesivir is an antiviral drug whose effectiveness remains uncertain to me and many others, including the WHO. Bamlanivimab is a monoclonal antibody that targets the virus itself. It's a drug that the Canadian Agency for Drugs and Technologies in Health evaluated as neither practically implementable nor of clinical value.
The federal government, through Health Canada, purchased remdesivir at a cost that is not publicly known, but that I would estimate to be $75 million. On the other hand, the government also purchased what I believe to be $32 million worth of bamlanivimab. This expenditure of approximately $100 million on effectively useless drugs contrasts with the shortage of the two life-saving treatments that currently exist.
What is urgently needed is a pan-Canadian committee of national experts with experience in clinical practice guidelines and expertise relevant to COVID-19, comparable to NACI, the National Advisory Committee on Immunization, who can share knowledge and data and come up with sensible recommendations.
I'm sensitive to the challenges faced by our federal government in nudging provinces and territories to row in the same direction. Clearly, this is an area in which the government has not been successful. Accordingly, I, along with several of my colleagues from around the country who have been involved in the development of provincial guidance, have decided to mobilize, mainly because of the urgency of the need and the importance of this to Canadians. These challenges are too great to defer any longer to the various levels of government.
In the meantime, it would be wise for this committee and the federal government to figure out how our group of national experts can either be supported immediately or catapulted to a future state where such a committee exists for all infectious diseases. As I said at the beginning, drug-resistant infections are not going away, and we need to approach their treatment with a pan-Canadian, evidence-based lens that brings together the interests and expertise of all people from coast to coast to coast.
Thanks, Mr. Chair, and I apologize for disappearing. We had a technical emergency at this end and I wasn't able to hear the first two witnesses.
I want to thank you, Mr. Chair, and members of the committee for inviting the Canadian Nurses Association to appear today. My name is Mike Villeneuve, and I'm the CEO at the Canadian Nurses Association. I'm delighted to have my colleague, Aden Hamza, who is our policy lead, here with me.
In December 2020, Canada reached a much-anticipated milestone, as you will know, as the first doses of the COVID-19 vaccine arrived and immunization programs began across the country. This gave nurses and people living in Canada the hope that the unprecedented global crisis may be brought under control. Never in history has the world of science come together at the same time to solve a common threat to humanity and, globally, scientists have deployed new techniques, shared their findings openly, and worked around the clock with governments and regulators while preserving safety.
Two weeks from yesterday, we will mark the one-year anniversary since the WHO declared COVID-19 a global pandemic. Day after day since then, health care workers and vulnerable populations have been suffering the most due to the pandemic. As a key step in eliminating this crippling virus from our society, the Canadian Nurses Association is strongly recommending that everyone living in Canada take the vaccine as it becomes available to them. In addition, clear guidelines and a strong nursing and health care workforce will be critical to successfully deploying a mass COVID-19 immunization program.
Nurses will be central to the delivery of the COVID-19 vaccines across Canada. In fact, it was a nurse in the U.K. who gave the world's first COVID-19 vaccine to a patient. As nurses, we historically have been at the forefront of immunization programs. A vast amount of vaccine delivery into the arms of human beings was carried out by nurses globally, and we have always been strong supporters of science. This was demonstrated in Canada as we saw many nurses be the first to roll up their sleeves to be vaccinated in December.
As the largest group of health care professionals in Canada, nurses are playing a critical role not only in administering vaccines but in educating the public and encouraging vaccine confidence. In carrying out their roles, nurses are ethically bound to give evidence-based, accurate, timely and non-judgmental information to patients. CNA has been committed throughout this process and is playing a key role in promoting vaccine acceptance and supporting nurses through clear, consistent messaging and evidence-informed resources.
I will conclude, Mr. Chair, by saying that CNA continues to be extremely concerned with the critical problems we've witnessed during the pandemic. The long-term care sector continues to suffer the most, and even with lessons learned from the first wave of the pandemic, the second wave has rehashed vulnerabilities in these homes and settings, leading to new outbreaks and many deaths of older adults.
We are also extremely concerned with the mental health and burnout of nurses and all health care workers in Canada. The worsening mental health of nurses could lead to long-term effects for those nurses as individuals but also for the health care system, including amplifying nursing shortages, which seems to be a concern in some parts of Canada. Last year, we asked nurses and found that their mental health had deteriorated significantly throughout the year with over half stating that their mental health was only fair or worse than fair.
Urgent action from all of us, certainly from governments, is needed to address these challenges. Federal, provincial and territorial governments need to remain vigilant and continue to hear the expert voices of nurses and other health care professionals.
Thank you, Mr. Chair, and Aden and I will do our best to answer any questions.
Good afternoon, and thank you to the committee for having me back today.
It has been said many times that this is a global pandemic that requires global solidarity and global actions. In addition to protecting Canadians, it is essential that our government unite behind a truly global response. Doctors Without Borders, or Médecins Sans Frontières, MSF, teams have witnessed a severe second wave of the COVID pandemic in many of the places where we work. In places such as Mozambique, Malawi and Zimbabwe, health systems have struggled to cope with the sudden onslaught of patients. Several African countries have recorded more COVID-19 cases in the month of January 2021 than in all of 2020 combined, and in many countries, the indirect impacts of the pandemic, in particular the disruption of essential health services, have been even more deadly than COVID itself.
My key message today is that our immediate global priority needs to be ensuring that health care workers and other people most at risk in low- and middle-income countries have equitable access to the most effective and contextually appropriate COVID-19 vaccines urgently. Unless we scale up access to vaccines in all places, the world risks generating new pandemics of vaccine-resistant COVID-19 variants. If we fail at equitable distribution of COVID-19 vaccines, we fail at global public health. It's that simple. This would be morally catastrophic and a significant risk to the public health of all people, including Canadians.
There are billions of people in the world who are almost exclusively dependent on the Covax facility as the source of their vaccines, yet it wasn't until Wednesday of this week that the first doses from Covax arrived in the first recipient country. That's because Covax itself is struggling to access doses in a timely way, in large part because the existing supply has so far been monopolized by high-income countries.
I want to emphasize that the only reason for Covax's existence in the first place is because the way that the world currently develops, manufactures and delivers new medicines and vaccines is broken. It is set up to maximize profits. The pharmaceutical industry is not set up to rapidly respond to emerging pathogens with pandemic potential. It is not designed to scale up manufacturing of new health technologies to meet global demand, and as we are seeing today and have seen for decades, it is not set up to ensure equitable access to new medicines and vaccines, particularly for people in economically poor countries.
We need to change the way the world develops medicines and vaccines, to prioritize developing the tools needed to respond to public health threats and making them readily available and accessible. There are vast areas of medicine that cannot and simply do not respond to the market. They're market failures. COVID-19 clearly falls into that category. A year and a half ago, there was no commercial interest in coronavirus vaccines. The same is true of Ebola and drug-resistant infections. As Canada moves toward a conversation of biomanufacturing of medicines and vaccines, it's essential that this not just be a conversation about how to incentivize private companies to build factories here. It needs to be a conversation that transforms our relationship with the way that medicines and vaccines are discovered, developed, manufactured and delivered.
This committee actually studied this issue during its study on federally funded health research in 2018. None of the recommendations made by the committee in that report have been implemented, though they could have helped avert parts of this crisis by demanding fair pricing, greater transparency and sharing of technologies, and global access to drugs and vaccines developed with Canadian public funding.
It is common sense that when the federal government invests in vaccine or drug development it would ensure that the final product is available at a fair price around the world, including in Canada, but that's not what happens. We know that Canadians are concerned by this, because more than 90,000 people signed MSF's petition calling on the federal government to attach conditions to federal funding to ensure that the medicines and vaccines we pay to develop are affordable and accessible to people who need them.
We have three recommendations today for this committee. One, Canada needs a timeline for making a percentage of its doses of COVID-19 vaccines available for use in low- and middle-income countries to vaccinate health care workers and other high-risk people. Canada has publicly released timelines for when we anticipate having a surplus of doses, so Canada should release a timeline for the sharing of vaccines. This committee should ask for it.
Two, push for the implementation of the recommendations in the 2018 study on federally funded health research and open science, which recommended that Canada make the funding provided to develop new medicines and vaccines conditional on recipients ensuring that they would be available to people around the world at affordable, fair prices.
Three, we request that the Parliamentary Budget Officer review any drugs and vaccines that have been discovered and developed with Canadian public funding to understand whether, under a different model of production, we might have more affordable and accessible options for things like the rVSV-ZEBOV Ebola vaccine. This vaccine was first developed with Canadian public funding and to date costs $98.60 per dose, unquestionably the most expensive vaccine in use in global health.
As always, I'm happy to discuss any of this in greater detail. Thank you again for having me back.
I think the big news for all Canadians today on the vaccine front is that the AstraZeneca vaccine was approved. We apparently have 20 million doses ordered.
Looking at the numbers, I'm not sure what to think of it. I would note that Health Canada has pointed out that some places have not allowed its use in those over 65. Health Canada regulators have said that the results are too limited to allow an estimated efficiency in those over 65. There seems to be a note of caution about its use for those over 65.
Now its efficacy seems to be a matter of question. The initial trials, I think, showed 62% generally, but when you used half the first dose, it was up to 90%. I see Health Canada is suggesting right now that it's 62% and WHO says 63% after eight to twelve weeks. However, there have been a number of studies reporting that after eight to twelve weeks with one dose, efficacy is 76% to 82%. This is perhaps somewhat confusing.
Here's the biggest number and the most interesting study, which doesn't seem to be that well reported. I think maybe the most significant evidence, apparently, is coming out of Scotland where they have over a million people vaccinated and over 400,000 people have received the AstraZeneca vaccine. They're reporting 94% reduction in hospitalization of those having had the AstraZeneca vaccine. That's surprisingly lower than those who had the Pfizer one. Moreover, those numbers for AstraZeneca's preventing hospitalization were of those aged over 80 years old, primarily.
Maybe we can start with Dr. Langley and Dr. Scott-Douglas from the task force, on Pfizer or on AstraZeneca and specifically its use in the elderly. Where is this going to slot in if we're not going to use it in the elderly?
I can start, Mr. Chair.
Thank you very much for the question and the wonderful summary of the evidence so far.
I think your summary has highlighted a couple of points, and I'll just deal with them briefly. One is that each trial has a slightly different efficacy outcome. When you compare a trial where the outcome is a positive PCR test plus one symptom with a trial like the AstraZeneca one, where the outcome is severe illness or some kind of really significantly important clinical illness, they're apples and oranges, and you can't compare them, so across these trials we have to be very cognizant of what we're comparing. Also, none of them have been compared head to head.
The second thing is that what we're seeing now is evidence from the fourth phase of clinical research, which is post-market authorization. This is a very important part of learning about vaccines where we see what the efficacy and effectiveness is in true rollout programs, so we have to continue observing that. I think we have complete confidence in Health Canada's review of the file and that it is a safe and effective vaccine and an important part of the armamentarium to wrestle this pandemic to the ground.
I'm not exactly sure what the question is, but I can comment on it.
I will say that the data that we have from the trials so far is markedly limited. The number of end points is quite small.
There are two real challenges with bamlanivimab. One is identifying the people who will benefit, which is difficult to do early on. The number of people who would need to be administered the drug in order to prevent just hospitalization is in the order of about 100 people just to prevent one hospitalization.
More importantly, because it's a drug that needs to be administered intravenously, the course of therapy is really two hours: one hour for it to be administered and then another hour of observation. We would have to do that for the people who are most infectious early on in their course when they would be most infectious. On top of that, in order to identify them, first you need to get a positive test. What would normally happen in most centres around the country is that someone would be tested, and then they would get their information two or three days later. Then they would have to be brought back when a lot of that early benefit would be lost. For all of these reasons, the implementation challenges as well as the lack of information, it is a drug that, at the moment as far as we know, doesn't hold tremendous promise.
I will also point out one other thing that has been observed in the BLAZE trials. When bamlanivimab is used as monotherapy—it's used alone—we see these escape mutants, which are variants that are resistant to some degree to the immune system, escaping. What we would rather have and what the evidence suggests is combination therapy. We don't have a second drug, and obviously that adds to more complexity and cost.
I think the point you're getting at is that this is a global public health emergency and what happens in one country affects all of us everywhere. Disease control and public health interventions that are applied inequitably or only in one country will simply not be effective at ending the pandemic. We live in an interconnected world, where disease knows no borders.
To the question of vaccines and vaccine access, I think it's very clear that what we have seen over the past three months, as vaccines have started to roll out, is that the vast majority, almost exclusively all, of the vaccine doses that have been administered have been administered in high-income countries. As I said, there are only this week shipments of COVID-19 vaccine doses arriving in countries through the Covax mechanism. A large reason for that is that the available vaccine supply has largely been monopolized by high-income countries up to this point. We face a fundamental problem of high need, high demand, and extremely limited supply up to this point.
On the issue of Covax specifically, I want to be very clear that I actually think that Canada's participating in Covax as a purchasing country was appropriate at the outset. This mechanism was intended to be a global procurement mechanism that would be guided by principles of equitable access to prioritize high-risk health care workers and other vulnerable people as a global priority. That was the deal. We vaccinate the people who are at highest risk in every country everywhere as a matter of urgency. Having purchasing countries participate in that to demonstrate that we're not just invested in this as a charitable function but also as a mechanism for changing the way we procure and distribute vaccines I think was appropriate.
To then also sign bilateral agreements for a large number of vaccine doses, which is the situation Canada and other high-income countries are in today, and to then go and draw on the Covax mechanism at the same time as effectively monopolizing the global supply—I think that's not appropriate. The solution here is that Canada should sit this first round out, because we need those Covax doses to be going to countries that are entirely dependent on Covax as their procurement mechanism and who don't have the same kind of bilateral deals that Canada and other countries have.
That's probably a 10-hour conversation. I will try to narrow it as much as possible and focus first on the public health measures you have suggested.
I think one thing we haven't done well in Canada in particular is to take on a national or pan-Canadian strategy. Instead, we have a mixture of strategies. The territories and the Atlantic provinces have taken a maximum suppression approach. That has unquestionably saved lives, and it doesn't appear to have substantially harmed their economy, whereas all of the other provinces have taken a pure mitigation approach. How do you get there? I don't think there's any question of how you get to a maximum suppression strategy. The Atlantic provinces and the territories have demonstrated how to do that. That includes tight controls on the movement of people and travel, aggressive testing, contact tracing, isolating and supporting those who need help in all those aspects.
It's a very data-driven approach that targets zero, even though you may not actually achieve zero. I think as a national strategy, if there were to be a national strategy, then all the things that would be included in those would be necessary.
It looks like I don't have time to answer on the drugs.
The meeting is resumed.
Welcome back, everyone.
We are resuming meeting number 21 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.
As an individual, we have Dr. Cécile Tremblay, full professor, Université de Montréal. From the Canadian Association of Emergency Physicians, we have Dr. Alan Drummond, co-chair, public affairs committee; and Dr. Atul Kapur, co-chair, public affairs committee. From the Public Health Agency of Canada, we have Mr. Iain Stewart, president, who will be making a presentation. And we have Major-General Dany Fortin, vice-president of the vaccine rollout task force, logistics and operations, who will also be making a presentation.
We will start now with witness statements. I would remind everyone that I will be using a yellow card to indicate when there's about a minute left, if I don't forget, and a red card when your time is up. When you see the red card, please try to wrap up.
We will start with Dr. Tremblay.
Dr. Tremblay, you have the floor for six minutes.
My name is Cécile Tremblay, I am an infectious disease specialist and medical microbiologist at the Centre hospitalier de l'Université de Montréal. I hold the Pfizer University of Montreal chair on HIV translational research.
I have been working for decades on correlates of protection that could be used for vaccine development in HIV. This goal has long eluded us for HIV, so we've been thrilled to see the rapid development of viral-effective vaccines against COVID-19 in such a short period of time.
Several challenges persist. Vaccines do not stop pandemics; vaccinations do. Three factors will determine if herd immunity can be achieved in Canada through vaccination.
First is the availability of vaccine supply. Canadian researchers have been working hard on developing new vaccines. This work has been supported by the Canadian government through CIHR and other funding mechanisms. However, the time frame for the development of a new vaccine amenable to clinical trial in Canada is unlikely to yield products available for us in 2021.
I'm talking about the homegrown vaccines in Canada. These research efforts, though, should continue to be supported, as they may become useful if the pandemic persists, or if variants render our present vaccines obsolete.
At the moment, we have to rely on existing vaccines, which are in short supply not only in Canada, but throughout the world. Because of our deficient Canadian vaccine manufacturing infrastructure, we have had to rely on the importation of vaccines produced elsewhere with all of the delays that creates.
The lessons learned from previous pandemics had identified the need to produce vaccines in Canada as a priority, as part of a pandemic preparedness plan. Unfortunately, little was done and although we have had some companies manufacturing vaccines in Canada such as Sanofi Pasteur in Toronto and GSK in Quebec City, the capacity for large-scale production is limited.
The recent initiative of the federal government to develop a vaccine manufacturing facility in the Royalmount district in Montreal is commendable. Other facilities associated with research centres are also being created, such as the one in Saskatoon.
However, if we want to develop sustainable infrastructure for vaccine development and production in Canada, we must also support the presence of a variety of pharmaceutical industries, from homegrown biotechs such as Medicago in Quebec City, to big pharma. This will maintain the scientific expertise in Canada and avoid the brain drain of our young researchers to the U.S.
This means reversing an unfortunate trend over the last decade. In 2007, AstraZeneca and Bristol Myers Squibb shut down their manufacturing operations. In 2010 Johnson & Johnson and Merck's research centre in Montreal closed. Several other companies such as Pfizer, Abbott, and other research facilities that were based in Quebec were also relocated abroad.
If we want to make sure that we have sufficient vaccine supplies for the next pandemic, then we need to have an infrastructure that includes both a government-administered manufacturing capacity and a strong pharmaceutical industry presence.
The second factor in achieving herd immunity is the ability to establish mass vaccination programs that are accessible to the entire population. From what we can observe in Quebec, this seems to be quite well organized.
The third factor is vaccine hesitancy. This is not specific to COVID-19. Misinformation on vaccines has been circulating for decades, and has accelerated in recent years on social media. COVID-19 has intensified conspiracy theories, which have instilled fear in a significant proportion of the population.
To achieve herd immunity it is believed that 75% to 85% of the population needs to be vaccinated. At the moment a good percentage of the population is eagerly awaiting their vaccine. These are the low-hanging fruit. The challenge will be to reach out to those who are hesitant and not necessarily against vaccination, but who need to have their questions answered.
So far it is not clear to me what the communication plan is. People who are hesitant about getting vaccines are spread throughout society across all ages and socioeconomic strata. Specific communication strategies must be developed to address their various concerns.
Finally, phase three vaccine clinical trials usually exclude certain populations, such as immune-compromised and HIV-positive people, transplant patients, cancer patients receiving immunosuppressive therapies, and pregnant or breastfeeding women. However, we know that these populations could benefit from vaccines, but we are always in the grey zone, because data has not been collected. It could be, because of their immunosuppression, that their antibody response may not be as high or effective. We might need to use a different strategy, such as adding booster doses.
Usually researchers initiate research projects, like I do, to test vaccines in these populations. They apply for grants and, if they are lucky, they get funded. There's always a problem in accessing the product that we want to test to conduct these clinical trials.
With phase 4, this is particularly true when the supply is limited, such as the case right now, so testing new vaccines in these various populations should not be left to individual initiatives. It should be mandated by the government, and resources as well as vaccines should be available automatically to conduct these phase 4 trials once the vaccines are approved.
In the midst of this devastating pandemic, vaccines are the shining light on the horizon. Let us learn from previous pandemics and build a durable infrastructure encompassing research and development and manufacturing and distribution so that we are ready for the next time.
I apologize. I thought Dr. Drummond was going to lead us off.
Thank you for the opportunity to appear. We plan to utilize our time by focusing on the immediate situation of vaccination and the vital need to engage with frontline workers and their associations. There are other points that we will be mentioning later on.
Our first priority has to be to repeat our call for increased transparency around the prioritization and administration of the COVID-19 vaccines and the plans for the vaccinations going forward. Unfortunately, there remains confusion, lack of transparency and mixed messaging around prioritization. We urge there to be central, federal coordination of efforts with clear, consistent and transparent messaging.
Why are we calling for this? It's because we see the stark example of this problem in the fact that there are still people working in Canadian emergency departments who have not been vaccinated or not completely vaccinated. Of particular concern for us are those working in smaller, isolated and rural communities. We are highlighting health care workers because of the precarious state of the health care system and its dependence on workers who are already overstretched. Plainly said, if our health care workers are incapacitated due to COVID-19, the system won't be able to take care of the population at large. As I said, but it needs reinforcing, most troubling is the fact that vaccination has been delayed for emergency personnel in rural and isolated communities. The risk there is that because they don't have as many people and as many backup personnel, the smaller population of providers means that there are not others who can step up and fill in for colleagues who fall ill. The risk of system collapse in rural communities is much higher. That also has caused frustration for health care personnel and added to the burden of working in a system that was already overloaded even prior to the pandemic.
We as health care workers have been repeatedly thanked. We've been hailed as heroes. The reality is that we are workers, no less than any others, who deserve a safe work environment. Instead, all too often the assumption has been that we will simply accept increased risks without consistent, evidence-based assessment and mitigation of those risks. In fact, we even saw last week one provincial government fail to recognize that emergency department nurses are a higher-risk group that treats COVID-19 patients often before they have been identified as cases.
Our members and our colleagues on the front lines have continued to step up and care for the sickest patients in our communities. Transparency, communication and adherence to an ethical framework in vaccine prioritization and administration are the minimum they should receive in return. We have seen many missteps up until now. We are looking forward to the ramp-up, but we want assurance that those missteps won't be enlarged and expanded as we ramp up.
We also want to talk about the conditions that hindered the response to the COVID-19 pandemic and that need to be addressed now in order to prevent a third wave that's even worse than the second and to support the health care system’s ability to respond and to resolve vulnerabilities prior to the next health care crisis. Think about the idea of a system that's resilient and able to respond. It needs surge capacity, which is eliminated when there's pre-existing crowding. It needs adequate staff, which requires HHR planning. It requires adequate supplies, which requires stockpiles, domestic production capacity, and a strategy to prevent shortages of medications and supplies. It needs an appropriate working environment, which requires hospital design. It requires adequate leadership and decision-making, such as an incident management system and clear communications.
At the beginning, we emphasized the point of keeping the system resilient, which requires vaccinating staff so that the capacity is there. I'll touch on a couple of these points specifically.
When we talk about surge capacity, we saw that hospitals completely shut down in wave one in order to create capacity to handle anticipated COVID-19 patients. Hospitals function most adequately and appropriately at 85% capacity. Even before COVID, most hospitals in this country were operating at or above 100%. That is not suitable; it is not appropriate. It wasn't then. It isn't now, and it won't be in the future.
We cannot go back to the old normal. That has added to the strain on emergency department workers. We have been and are continuing to see emergency department staff leave the emergency department to work elsewhere or leave the profession. Unfortunately, we have also seen at least one colleague who has been lost to suicide in the last year.
I see that my time is coming to an end. We have submitted a written brief with more details and we will be happy to answer questions from the committee.
Thank you, Mr. Chair and members of the Standing Committee on Health for inviting Major General Fortin and me to return today to inform and discuss with you our work on vaccines.
The Government of Canada has taken a whole-of-government approach to much of the work we have been undertaking in response to the pandemic. We've been relying on accumulating scientific data and emerging evidence and we've been pulling on expert guidance to inform our decisions, strategies and recommendations. We're also participating in international communities of practice in order to benefit from the experiences and developments in other countries.
As you know, we've begun our phased approach to vaccinating Canadians. I'm pleased to say that we are in track to complete phase one by the end of March. As expected, we're ready to move on for phase two in April. Major General Fortin will be speaking more about the upcoming “big lift” we require to get ready for the influx of additional vaccine doses.
Last fall, the vaccine rollout task force was established inside the Public Health Agency of Canada in order to provide public health and strategic policy advice to decision-makers and also to oversee the management of the delivery of the vaccine portfolio. That included logistical planning and tracking of data on a secure platform as vaccines are deployed and distributed across Canada and to provide leadership and support to the various fora of the immunization experts like the National Advisory Committee on Immunization or the special advisory committee. It is also managing vaccine surveillance programs for issues such as vaccine safety, effectiveness of the vaccines and the coverage of the vaccines as we deliver them.
In order to fulfill its mandate, this internal task force is working closely with provinces, territories, indigenous leaders and communities across the country to support a consistent approach to COVID-19 immunization. The task force's expert advice and leadership have been invaluable over the past quarter and will be invaluable going forward as we move into the second phase.
Throughout the pandemic, public health practices and efforts of all Canadians have proven to be effective in containing the spread of the virus. Our efforts have brought us this far, but we have to continue wearing our masks, washing our hands and physical distancing as we move forward, until the immunization campaign is well advanced.
We also need to rely on effective border measures to mitigate the further introduction and spread of the virus and the virus' variants into Canada. That is why as of this month, travellers arriving in Canada have to produce at the border a molecular test done before arrival in Canada. They are tested again on the day of arrival and on day 10 of their quarantine. They have to continue to present quarantine plans that are appropriate and contact information for us for following up with them.
COVID-19 virus variants of concern have emerged in countries around the world. There is evidence that these variants are more easily transmitted. There is the risk that they cause more severe illness. These variants require our attention and we need to track them. We need to learn more about them and we need to use science to guide us.
In this regard, the Government of Canada recently allocated $53 million in funding for an integrated variants of concern strategy that builds on sequencing, research and surveillance capacity for detecting the variants and informing public health measures. This vital work has provided decision-makers with the latest science on controlling for variants of concern and will continue to respond accordingly and explore options for variants, such as vaccine boosters to control against their spread.
Canada has successfully secured a diverse portfolio of vaccines to vaccinate everyone in Canada who wants to be vaccinated, by the end of September. To this end, Canada has negotiated advance purchase agreements with seven pharmaceutical companies. This includes a diversity of vaccine technologies, including two mRNA vaccines, which are Pfizer and Moderna. As of this morning, as you'll know from the announcements, AstraZeneca has been authorized by Health Canada as well.
Several other vaccines are currently under review using the rolling review process Health Canada has developed. AstraZeneca will help with the immunization campaign starting relatively soon. I believe today, as well, an announcement was made about initial early doses, which will help us begin to take on board these new viral vector vaccines as part of our immunization campaign.
Last fall, NACI, the National Advisory Committee on Immunization, identified priority populations that would be vaccinated first. In anticipation of increased supply, they will be updating their advice on who should be the priority populations. We will continue to be guided by their evidence and their advice in the work that we do.
Thank you very much, Mr. Chair.
Thank you very much, Mr. Chair and members of the standing committee. I'm pleased to provide the committee with an update on the progress we've made so far and our plans for moving forward to provide all Canadians with vaccines by the fall.
So far, the national operations centre here at the agency has distributed nearly two and a half million doses of both approved vaccines—Pfizer-BioNTech and Moderna—with approximately three and a half million coming next month to round out our six million announced commitment from both manufacturers.
Since last December, we have been working on a plan that will allow us to deliver authorized vaccines safely, efficiently and as quickly as possible to provinces and territories. We deliberately implemented a phased approach so we could establish our capacity to distribute vaccines and support the provinces and territories to administer the vaccines. We completed a series of tabletop exercises and various discussions and rehearsals with the provinces and territories to ensure that all critical capability gaps were filled, risks were identified and mitigated, that the plan was resilient and contingencies were in place to secure the vaccine supply chain. That continues today.
As part of our soft launch approach last December, we started with early deliveries of authorized vaccines to 14 designated points of use on the 14th of December across Canada. As we moved forward, we expanded the number of distribution sites. Last week alone, 107 vaccination sites were used for Pfizer and 83 for Moderna.
Also, I personally conducted multiple bilateral meetings with counterparts from provincial and territorial vaccine rollout leads as well as federal stakeholders to ensure that we're all on the same page. We continue to have those moving forward.
Over the last two months, Canada was significantly affected by COVID-19 vaccine shortages and delays as Pfizer-BioNTech and Moderna reduced production rates at their respective European facilities. This created a temporary delay for deliveries to Canada, but the improvements in manufacturing are now allowing for greater productivity. We are now coming out of this trough.
From the beginning, we have been open with our partners and stakeholders about fluctuations in supply and the need for contingency plans.
I want to emphasize that we are expecting 444,000 doses each week in March from Pfizer-BioNTech and that Moderna will send the full 2 million missing doses. We are on a very good track from our perspective.
From April onwards, we expect a sharp increase in the availability of licensed vaccines against COVID-19. As we announced this morning, we will receive two new vaccines from AstraZeneca, and these quantities will be added to the totals for these two productions.
More than 23 million doses are therefore expected to arrive between April and June. This includes the advance delivery of an additional 2.8 million doses of Pfizer-BioNTech, which was planned for this summer, but will now occur in the spring.
The National Operations Centre at the Public Health Agency of Canada continues to lead the planning effort to ensure that the provinces and territories keep pace with the increased deliveries of licensed vaccines. In addition, the National Operations Centre continues to ship different types of freezers to ensure ultra-cold and cold chain storage for different products, further building capacity in the provinces and territories.
Our collective efforts over the past months and weeks, the initial testing of our distribution and logistics systems, and the launch of the Pfizer-BioNTech and Moderna vaccines have all served to set the stage for rapid scale-up in anticipation of the increased availability of vaccines in the coming weeks and months. The same approach will be taken in the coming weeks for the additional vaccines, in close collaboration with the provinces and territories.
Coordination and collaboration with our federal, provincial and territorial partners is key to the success of this operation. We regularly give them updates or inform them of changes to the distribution plan and ensure that we give them as much visibility as possible on future quantities as soon as we can.
Mr. Chair, in conclusion, our work to enable our provincial and territorial counterparts continues to be done proactively and transparently. This is a co-operative effort that touches on everything from vaccine availability to enabling equipment, to considerations by health care practitioners. We're are in close coordination, and we will continue to be so over the next several months. Every step of the way, to ensure that vaccines continue to be delivered efficiently and safely across regions in Canada, we've been working collaboratively with all stakeholders, and we'll certainly endeavour to do so moving forward.
With that, subject to your questions, this concludes my introductory remarks.
Thank you, Mr. Chair.
I thank the witnesses for being here.
I will address you first, Major General Fortin. It is a pleasure to see you again.
In your speech, you talked briefly about coordinating with provinces. First of all, I want to clarify one thing for everyone: you are responsible for the logistics of vaccine distribution in the country, but you are not the one who signed the contracts in advance or negotiated them. You are in charge of distributing the vaccines that are delivered.
At first, the quantity of doses to be distributed was very small, but now, we are going to receive a lot of vaccines at the same time.
Have the provinces raised an objection saying they can't handle it, or is everything okay?
If there are problems, which provinces are concerned?
We previously announced that we will have 23 million doses from Pfizer and Moderna during the second quarter. In the third quarter, we will be receiving more than 55 million doses. That will give us a total of 84 million doses from those two manufacturers alone.
Today, we added AstraZeneca to our portfolio of vaccines. The exact quantities we will receive during the second and third quarters still have to be confirmed. However, we can easily see that about 25 million doses will be added to our portfolio of vaccines starting in March, according to the announcement by the Serum Institute.
Those are some of the projections we have communicated to the provinces. Of course, we have to turn to the provinces quickly to tell them about the quantities we will be receiving shortly and to inform them about the distribution process. We want to avoid situations in which quantities arrive unannounced on a clinic's doorstep.
We will clearly have to plan quickly for the first deliveries of the doses from AstraZeneca.
My first question is for you, Dr. Tremblay.
Welcome, and thank you again for joining us.
People are concerned about the arrival of the variants. Modelling by the Public Health Agency of Canada showed that, if the public health measures were relaxed too quickly, we could have up to 20,000 new cases per day. The Institut national de santé publique du Québec, INSPQ, was talking about 2,000 new cases per day in Quebec alone.
Do you believe that those measures must be relaxed, or tightened even more? Some claim that we need to tighten them even more until we have a critical mass of people who have been vaccinated.
Thank you for your question, Mr. Thériault.
It is important to be concerned about the variants, because they could completely change the dynamics of the epidemic. Currently, the number of cases and hospitalizations is going down, but everything could change if the variants become dominant.
That being the case, I do not feel that this is the time to relax the precautionary measures we have taken up to now. In Quebec, some loosening during the school break week was allowed, but we are all a little frightened that it may subsequently cause a new spike in cases.
In my opinion, we should not continue in that direction. Instead, we should continue to restrict gatherings as much as possible until we have a critical mass of people who have been vaccinated.